Claims

Policy Number*

First Name*

Last Name*

Email*

Phone*

Address*

State/Prov.*

City*

Zip Code*

Brand*

Model*

Year*

Battery Serial Number*

Reason For Claim*

Date Issue First Occured*

Describe the issue*

Photos of the Bike Serial Number*

Accepted file types: jpg, png, pdf, Max. file size: 2 MB.

Max. file size: 2 MB.

Photos of the Battery Serial Number*

Accepted file types: jpg, png, pdf, Max. file size: 2 MB.

Max. file size: 2 MB.

Provide Photo / BMS Reading (if available)*

Accepted file types: jpg, png, pdf, Max. file size: 2 MB.

Max. file size: 2 MB.

Have you recently made an modifications to the PEV*

Yes:

No:

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