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Damage Claim Submission Form
Date of Tow Towed From
Vehicle Make Vehicle Model License Plate Invoice #:
Description Of Damage
Contact Information Name (required) Phone# (required) Email (required)
Photo Documentation Please upload at least one clear photo showing the damage *Photo cannot be larger than 5 MB
CameraUpload Picture
Please Sign in the Field Below
Cerification I hereby certify that all information provided above is true and accurate to the best of my knowledge. I understand that it is unlawful and fraudulent to make false statements or claims.
