Step 1 of 4 25% Personal Contact InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryUnited StatesCanadaPuerto RicoPhone*Fax NumberEmail By providing your email address, you agree to receive claim documents electronically. 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 VinylCurrent Odometer*Date Product Purchased Dealership Name* 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*What was the cause of the damage to your vehicle?*Specify the location of the damage on your vehicle*(please be as specific as possible)What methods were used to attempt to remedy the damage?*Please provide the approximate date of your last overall cleaning?* Special handling instructions (i.e. vehicle is at dealership, located in gated community, etc.)Upload photos of damage4MB size limitUpload additional photos of damage4MB size limitUpload additional photos of damage3MB size limitUpload additional photos of damage4MB size limitUpload additional photos of damage4MB size limit 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 Siskin Enterprises, 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*Date CommentsThis field is for validation purposes and should be left unchanged.