To help expedite the entire claims process, please be sure to include all of the necessary information.  If you do not have all of the information please contact your Torque Group representative after you have submitted the claim.

Dealer Name:
Dealership Contact:
Dealership Email:
Customer Last Name:
Customer First Name:
Address Line 1:
City:
State:
Zip Code:
Date Sold:
Product (GAP,Tire,CL/AH,VSC,Theft,ect):
Policy # (if available):
Comments: