Defective Vehicle Claim Form

For a discussion about your situation with one of our friendly and approachable advisors please complete the form below and we will contact you at your convenience.

About you

Title

Please select your title

Full name Please enter your full name

Phone number Please enter your phone number

Email Please enter your email

Address Optional

Date of birth Please enter your occupation

Occupation Please enter your occupation

Where did you purchase the vehicle from

Full name/company details Optional

Address Optional

About your case

Description of vehicle purchased Optional

Purchase price Please enter the purchase price

Date of purchase Please enter the purchase price

How did you pay for the vehicle?

Please select an option

If paid for by credit card/finance, please provide details of finance company Optional

Please enter the verification code