Toggle navigation
Home
Submit claim
Team
FAQ
Contact
Home
Submit claim
Team
FAQ
Contact
Claims Procedure
Claim Information form
New Claim
Type of Claim
Lifetime BG Protection Plan
BG Pre-owned Vehicle Protection
BG Engine Assurance™
BG Forever Diesel™
One-Ton BG Protection Plan
Owner/Customer Name
First Name
Last Name
Phone
Address
City
State or Province
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Ontario
Quebec
Nova Scotia
New Brunswick
Manitoba
British Columbia
Prince Edward Island
Saskatchewan
Alberta
Newfoundland and Labrador
Northwest Territories
Puerto Rico
Postal Code
Country
USA
Canada
Puerto Rico
Vehicle
VIN
Current Odometer Reading
Year
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Make
Model
License Plate No.
Repair Company
Name of Repair Facility
Contact First Name
Contact Last Name
Address
City
State or Province
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Ontario
Quebec
Nova Scotia
New Brunswick
Manitoba
British Columbia
Prince Edward Island
Saskatchewan
Alberta
Newfoundland and Labrador
Northwest Territories
Puerto Rico
Postal Code
Country
USA
Canada
Puerto Rico
Phone
Fax
Email
Preferred Contact
Email
Phone
Resolution Info
Original Complaint
Failed Component
Brakes
Cooling System
Engine
Front Differential
Fuel/Air
Power Steering
Rear Differential
Transfer Case
Automatic Transmission
CVT
Manual Transmission
Resolution Description
Costs
Estimated Expenses for Material & Parts
$
Labor Rate per Hour
$
Tax Rate (parts only)
%
Eg. 1.00% = 1%, 100.00 = 100%
BG Service Used
Engine Oil Service
Premier Oil Change Service
Performance Oil Change Service
Diesel Injection Service
Extended Drain Engine Oil Service
Fuel/Air Induction Service
Transmission Service
Cooling System Service
Power Steering Service
Drive Line Service
Brake Service
Climate Control Service
Battery Service
BG Quick Cure® Headlight Restoration
Ethanol Fuel System Defender Service
BG 44K®
Diesel Engine Oil Service
DPF & Emissions System Restoration Service
GDI Fuel/Air Induction Service
GDI Performance Oil Change
Diesel Induction Service
Documents
Submit the following information:
All service repair orders indicating compliance with terms and conditions of the BG Protection Plan, including BG part numbers, retail prices and labor charges.
If a pre-owned vehicle, BG PVP registration card number and Bill of Sale.
The lease agreement, if the vehicle is leased.
The estimate for repairs, including part numbers, prices and labor hours. If the repair in question has not been fully diagnosed and/or torn down, the Repair Facility must get the customer’s authorization to do so and email or fax(1-316-265-6047) CCM when a complete diagnosis is available. (Charges for diagnostic procedures and teardown costs are not covered unless they are an integral part of the repair.)
If you have problems uploading you may fax the required documents to 1-316-265-6047
Upload Document 1
Upload Document 2
Upload Document 3
Upload Document 4
Upload Document 5
Upload Document 6
Upload Document 7
Upload Document 8
Upload Document 9
Upload Document 10
Upload Document 11
Upload Document 12
Upload Document 13
Upload Document 14
Upload Document 15
Upload Document 16
Upload Document 17
Upload Document 18
Upload Document 19
Upload Document 20