Get Customer Claim Form

Filling out the Customer Claim Form online is a straightforward process that assists users in documenting their vehicle-related issues effectively. This guide provides step-by-step guidance to ensure you complete the form with accuracy and ease.

Follow the steps to complete the Customer Claim Form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your personal information in the Customer Name and Address section. Fill in the relevant title (Mr., Mrs., or Ms.), first name, last name, street address, city, state, zip code, and daytime and evening phone numbers. Make sure to include a valid email address for communication regarding your claim.
3. Provide the Vehicle Information. Include the name(s) that appear on the vehicle title, vehicle make, model, year, vehicle identification number, current mileage, and delivery date. Indicate if it is a leased vehicle and whether the vehicle was purchased used. Additionally, specify if the vehicle is used for business purposes.
4. In the Vehicle Problem(s) section, clearly describe the issues experienced with your vehicle. List any dealers that attempted repairs, including dates, mileage, and repair order numbers. Make sure to circle whether the problem currently exists.
5. If the vehicle has been involved in an accident, provide the date and specify the damaged area. Assess the resolution sought by choosing from the options provided: repurchase, replacement, repair, or reimbursement.
6. After completing the form, review all the information to ensure accuracy. Once confirmed, provide your signature and date the form. This acknowledgment is essential for validating your claims.
7. Return all copies of this form by mailing it to the California Dispute Settlement Program at the specified address or via the provided email address. Ensure that you keep a copy for your records.

Start completing your Customer Claim Form online today!