Supplement Request

Please fill out this form as accurately as possible. The information you provide will help Legacy Claims Services direct your supplement request to the appropriate team.

To get started, please have your Legacy Claims file number, claim number, and the last name of the owner or claimant ready.

In order to send a supplement request you must supply 2 out of four options below. It can be any combination of the four options.

Enter File Number

Enter Claim Number

Enter Owner Name

Last 6 of VIN

Attachment

Details

SUPPLEMENT REQUEST

Supplement Request