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Claim Authorization 
Please complete the claims submission form below.

If you have questions, or would like more information, please send email to support@oemwarrantyrisk.com

Customer - Company Name
Customer First Name:
 *
Customer Last Name:
 *
Customer Address:
 *
Customer City:
 *
Customer State:
 *
Customer Zip Code:
 *
Program Type
Problem Discription:
 *
Product Serial Number
 *
Product Model
 *
Date of Loss
 *
Date Repaired/Resolved
 *
Parts Used
Shipping Costs
 *
Parts Costs
 *
Labor Costs
 *
Amount of Claim $
 *
Who is the Payee?
Payee Name & Address
 *
Claim Submitter's Email
 *
Security code:
 *
Do not enter anything in this field:
* indicates a required field


OEM Warranty Risk Inc.
4745 West 136th Street Suite 77
Leawood, KS 66224
Phone: 1-888-OEM-RISK
Email: info@oemwarrantyrisk.com

 

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