Fields marked with * are required fields. Step 1 - Personal Contact InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country*United StatesCanadaPuerto RicoPhone*Fax NumberEmail Enter Email Confirm Email By providing your email address, you agree to receive claim documents electronically.Section 2 - Vehicle InformationModel Year*Vehicle Make*Example: Mercedes, Porsche, Toyota, Chevrolet, Honda, etc.Vehicle Model*Example: Prius, C CLass, Accord, Impala, BoxsterVehicle Identification Number (VIN)*Exterior Color*Interior Color*Seat Material*FabricLeather or VinylOtherCurrent Odometer*Step 3 - Warranty Registration InformationThe prefix letter(s) and number are located at the top right corner of your Customer Registration Form.PrefixNumberDate Product Purchased Dealership Name*Step 4 - Claim Description InformationPlease Note: All dates will be required in order to process any claim.Date damage was noticed* Please provide a brief description of the damage*Specify the location of the damage on your vehicle*(please be as specific as possible)Special handling instructions (i.e. vehicle is at dealership, located in a gated community, etc.)Upload Photos of Damage4MB maximum per imageUpload Additional Photos of Damage4MB maximum per imageUpload Additional Photos of Damage4MB maximum per imageUpload Additional Photos of Damage4MB maximum per imageUpload Additional Photos of Damage4MB maximum per imageWhat was the cause of the damage to your vehicle?*What methods were used to attempt to remedy the damage?*Please provide the approximate date of your last overall cleaning?* Step 5 - Acceptance and SubmissionPlease read the following statements carefully, as a claim will not be processed unless initials from the claimant have been provided.Please type your initials to indicate: I am aware that PermaPlate Company LLC, Inc. relies on the information and statements above. I hereby certify that the above statements are complete and accurate to the best of my knowledge. Any fraudulent statements will result in invalidity of warranty. Initials of Acceptance*EmailThis field is for validation purposes and should be left unchanged.