Claims

I am the: (required)

Personal Information

First Name (required)

Last Name (required)

Country

Address Line 1 (required)

Address Line 2

City (required)

State (required)

Zip (required)

Phone (required)

Email (required)

Contact Preference

Vehicle Information

VIN (required)

Make (required)

Model (required)

Year (required)

Xzilon Contract Number

Mileage (required)

Claim Description Information

Have you attempted to clean or repair?
Yes No

Damage Types
Select all that apply
Paint Oxydation
Hard Water Etching
Tree Sap Damage
Bird Dropping Damage
Love Bug or Other Bug Damage
Road Salt Etching<
Interior Stain
Interior Rip/Tear/Burn
Exterior Dent Less Than 3"
Wheel Abrasion / Curb Rash
Windshield Chip
Windshield Crack
Paint Damage
Touchscreen Crack/Scratch
Touchscreen Chip

Select Damage Locations (required)
Hood
Fender
Door Panel
Bumper
Roof
Trunk / Cargo Lid
Driver Seat
Passenger Seat
Rear Seats
Carpet
Wheel: Front Left
Wheel: Front Right
Wheel: Rear Left
Wheel: Rear Right
Windshield
Touchscreen
Quarter Panel
Center Console
Pillars
Dashboard
Cross Members

Date of Damage (required)

Detailed Damage Description (required)

Submission

IMPORTANT (required)

Please read the following statements carefully. Claims will not be processed unless the full name of the claimant has been provided.

Please type your full name below to indicate:

I am aware that Xzilon relies on the information and statements above. I hereby certify that the above statements are complete and accurate to the best of my knowledge. I understand that any inaccurate information entered on this form could affect the outcome of the claim, including denial of the claim.

Signature (required)

Claims

File Claim

Claim Form