Pre-owned Claim Submission "*" indicates required fields Dealership/Repair Facility* Dealership/Repair Facility City/State* Service Advisor Name* Service Advisor Email Address* Service Advisor Phone Number*Customer's Name* Enviroway Rep Name* Has Rep Been Notified? (Y/N)* YES NO VIN Number*Vehicle Make, Model, Year* Have Repairs Been Started On this Vehicle? (Y/N)* YES NO When Was the Used Car Inspection Performed?* MM slash DD slash YYYY Has this Vehicle Been Sold?* YES NO What Mileage was this Vehicle Serviced With Enviroway Pre Owned Protection Kit?*What is the Current Mileage?*Customer Concern: Why Did Customer Bring Vehicle In?*Correction: What Work Needs to be Approved to Fix the Problem?*Estimated Repair Costs* Used Car Inspection, RO Showing use of Enviroway Pre Owned Protection Kit, Current Repair Estimate Including Parts and Labor Itemization Costs (Please Attach All)* Drop files here or Select files Max. file size: 512 MB. Is the failed Component Covered by Any Other Type of Warranty or Service Contract? (Y/N)* YES NO Claim Submission Date* MM slash DD slash YYYY CAPTCHA