Co-op Claim Form

Submitting a Claim

There are two ways to submit a claim. You can get started online by using the form below to send in your information, or download the co-op claim form to mail / fax.

Online Claim

1. Dealership Info

Dealership Account Number

Dealership Name

Phone

Postal / Zip Code

Dealership Contact

1. Co-op Claim Summary

Saved Dealer Info

Edit

Claim Items

None

Submit Claim

2. Ad Info

Ad Title / Product

Publication Date

Publication / Station / Tradeshow

Percent of Time/Space used for Unverferth	Total Cost of Ad	Ad % Cost for Unverferth Products	Co-op Credit Percentage	Co-op Amount Requested

If you would like to request a different amount than what is calculated above, please add the details to the notes below.

3. Notes

4. Attachments and Links

An invoice for the advertisement must be provided to begin the claim.

File Attachments - May not exceed 15Mb total per claim item.

Link to Ad Webpage

5. Save Claim Item