Product Search
Register for the Roadside Assistance Program
Search
Login
Cart
Register for Roadside Assistance

GAP LIFETIME PROTECTION CLAIM FORM

Customer

Enter your customers information below.

Vehicle

Enter your customers vehicle information below.

Claim

Enter the claim information below.

Technician Diagnostic Report

Please include the technician's diagnostic report and the repair estimate with your claim submission.

Supporting Documents

You must include all supporting documentation to support this claim. This includes, but is not limited to, oil change records, fluid service records, fuel service records, and any other relevant repair orders (ROs). All submitted ROs must include the applicable GAP Part Number.

Dealer

Enter your dealership information below.

GAP Representative

Enter your GAP Sales Representative information below.

Only qualified vehicles operated and repaired at an approved professional authorized dealer’s service center in Canada are eligible for coverage. Certain restrictions apply. See Program TERMS & CONDITIONS and EXCLUSIONS for more details.

Services Inquiry

Fill out the form below, and we will be in touch shortly.