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File a Claim

The personal information collected in this form is used only for the purpose of filing the claim or contacting you. We will NEVER share your personal information.

Please let us know your name. We really need it so we know who you are. If you cant get this one right, we really are gonna have problems on the rest.
Please add a Sur Name, a last name, whatever you call it. We need something here so we can all go on. You're holding us up.
Please give us a way to reach you! 803-555-1234
yeah....That's not a valid email. Try Again.
Need an address, please.
Choose a state, por favor.
Select a state, please. It's ok, we know you didn't mean to.
Please enter a zip code... look at a bill envelope if you can't recall, there are plenty of those.
Enter a REAL company please, and cant be blank.
Again, have to have it, please check carefully.
Please choose a date, Bob.
Need something brief here.
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Please enter who made your vehicle... Chevy, Ford, etc.
The VEHICLE MODEL please, Impala, Corolla, etc.

It's easy. Pick One. Please.
HEY, put SOMETHING here...
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Are you not human, cause you FAIL.
Call Us
+1(803)-951-7200
Drop us a Note
1612 Augusta Hwy. • Lexington, SC 29072

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