CUSTOMER CLAIMS FORM

1 Customer

2 Vehicle

3 Claim

Agreement Number:

Enter your agreement number and the last 8 of your VIN, then click Lookup to fill the form automatically.

Customer Name:

Customer Address:

Customer City:

Customer State:

Customer Zip:

Best Time To Contact:

Preferred Contact Method:

Home Phone:

Cell Phone:

Work Phone:

Email:

YOUR ROAD TRIP IS WORRY-FREE WITH ASC WARRANTY!

ASC Warranty
P.O. Box 2400
Mountain Home, AR 72654

Dealer Services: (800) 442-7116
Claims Administration: (800) 264-5090
Roadside Assistance: (888) 207-0166