Please fill out and submit the form below. After submitting this form, you will receive a confirmation email with your claim number and information.
If we require more information to submit your claim, a claims representative will be in contact with you.

In the "What happened?" section, please include all details of the incident (if available) including:

  • Type of damage (mechanical, body, etc)
  • The current location of the equipment

*: required field.

Certificate/Policy Holder Name (or Business Name) *
KCC Account #/ KTAC Policy #/ or Equipment Serial # *
Email *
Address1 *
Address2
City *
State *
Zip *
Phone *
Date Damage (Incident) Occurred *
Description of Damages *
Preferred Repair Dealership *
Transportation Requirements *

What we collect and why
you can learn more about how we handle your personal data and your rights by reviewing our Privacy Policy