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Online Claim Recommendation

Dealers Resource Center Easy Claims Online

Recommend stating that if the contract number starts with the below, to call to corresponding number:
  • + 55, 1000 – Mercury 877-232-9659
  • + ABG, ABI, AST, DTG, LG, AdminPlus – Assurant 888-282-8063
  • + DZE – Assurant 855-527-4026 or 702-912-4676

Repair facility details

Repair facility name:
Representatives name:

Customer details

Contract number:
Customer first and last name:
Customer phone:
Last 6 of VIN:
Year, make, model of vehicle:

Repair details

Repair order:
Current odometer reading:
Loss date:
Is this vehicle modified beyond manufacture specifications? YesNo

Is this vehicle used for business or commercial use of any sort? YesNo

Customer complaint:
Recommended correction:
Rental car issued:


Number of days:

Is rental car through repair facility?

If known, please provide rental agency details:

Was vehicle towed or driven in? TowedDriven

If known, please provide towing agency details:
Additional notes:

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