Customer Resources Form

Please fill out our form below to request maintenance, report an accident, return a vehicle, or for any other customer inquiries.

Comments

Issue / Concern:

Maintenance Request or Proof:

Truck Number should be listed below a QR code on the inside of your vehicle

Truck NumberVIN

Please take as many pictures as necessary to clearly show all damage.

Date of Accident:

Insurance Name:

Adjustor Name:

Policy Number:

Insurance Claim Number:

- THIS FORM IS NOT AN INSURANCE CLAIM -
Please call your insurance company to file a claim immediately after your accident, then fill out this form to notify us of your accident.

1st Driver Information

Location of Damage:

Year:

Make:

Model:

Plate:

Drivers License Number:

State

Was there another driver involved?

YesNo

2nd Driver Information

Location of Damage:

VIN:

Year:

Make:

Model:

Plate:

Drivers License Number:

State

Upload Images of Accident

Police Information

Were the Police at the scene?

YesNo

Issuing Badge Summons Issued at Scene?

YesNo

Summons Issued to Whom:

Nature of Summons; Accident Details

Description of Accident - Please use one (1) for your vehicle and two (2), three (3), etc. for other vehicles (as applicable)

Any Other Concerns or Items we can help with?

Describe your question or concern:

If this is a billing question, please enter your invoice number. Otherwise, leave blank:

Invoice Number:

What do you need maintenance on?

Describe your maintenance request:

What do you receive maintenance for?

Maintenance Document Submission

Accepted File Formats: .bmp, .gif, .jpg, .jpeg, .png, .tif, .qtf, and .pdf.

Describe the maintenance:

honey pot:

Contact Information

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