Please read the following statements carefully, as a claim will not be processed unless initials from the claimant / service advisor have been provided.
Please type your initials to indicate: 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 claim.
American Auto Guardian, Inc.
P.O. Box 925
Arlington Heights, IL. 60006-0925