Submit A Claim

To place a claim, please provide the following information:

(all fields are required)

Contract Number:
Your Name:
Your Phone:
Your Email:
Contact Preference: email      phone
Address:
City:
State:
Zip Code:

Any specific questions?  

   Enter Security Code Here:   

By providing your contact information, you are authorizing
CounterSurance to contact you regarding your claim and warranty coverage.