Claims RPS Claim Submission Form "*" indicates required fields Contact Name* First Last Phone*Email* Dealership Name*Zip/Postal CodeContract #Customer name First Last VINVehicle OdometerCustomer ComplaintCause of FailurePart Number & PricesRequested Labor Hours for RepairLabor RateTax RateLabor Manual/GuidePlease also upload a copy of the contract and copy of the RO with this form Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB. 844-601-2022 Renascent Protection Solutions 5500 Frantz Road Suite 100 Dublin, OH 43017
