Create New Claim

Fill out the form below to submit a new claim for review.

Customer Information

Customer Name *

Email Address *

Phone Number

Customer ID

Claim Type *

Priority *

Order Number *

Claim Amount ($) *

Claim Title *

Detailed Description *

Click to upload or drag and drop

PNG, JPG, PDF up to 10MB

Select Files

Please attach photos, invoices, or any relevant documentation to support your claim.

Incident Date

Assign To

Internal Notes

If you're unsure about any field or need assistance with your claim, our support team is here to help.