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888.361.9611 P.O. Box 457, Mahwah, NJ 07430
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SMART RISK INF0.
External Claim Form
Contract #
VIN
Model
Make
Year
Coverage Name
- Select -
Tire And Wheel
Windshield Coverage
Key Coverage
Paintless Dent/Ding Coverage
Roadside Assistance
Total Loss Protection
Etch
Nitrogen Tire Coverage
Maintenance Coverage
Chemical Appearance
Driver Protection Plus
GAP Coverage
DLP Windshield Protectant
Excess Wear And Tear
Vehicle Service Contracts
Smart Risk Auto
Service Contract
Month To Month Service Contract
Ultimate Smart Club
Interior Extended Care
Interior Extended Care
Drive Smart
Smart Risk Power Sports
Smart Risk Marine
Smart Risk RV
Canadian Smart Risk
Smart 360
Intellismart Auto
Intellismart Home
New York GAP Coverage
Q-Shield Protection
Smart Loan Protect
Smart Advantage
Customer Name
Your Email For Confirmation
Customer Address
Customer Phone Number
Sold Date
Selling Dealership
Dealer Phone Number
Name of Repair Dealer
Service advisor
I don't know
What is your Service Associate’s name?
Service advisor phone number
Service advisor email
Date you experienced you loss or needed to file your claim
Has this issue occurred before
No
Yes
Was your vehicle towed to the service facility
No
Yes
Claim Description
Claim images
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