Contact information
Company
*
First Name
*
Last Name
*
Email
*
Phone
Vehicle details
Plate number / VIN
*
Brand / Model
Delivery Date
*
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
MM
01
02
03
04
05
06
07
08
09
10
11
12
YYYY
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Whats the reason for your claim?
Mechanical defect
Optical defect (dents/scratche etc)
Incorrect description
Documents/accessories
Other
Detailed description of your claim
*
What do you expect from BCA? (Please mention the amount of your claim)
*
Add photos and/or documents
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