Who will be reimbursed for this claim? _____ dealer ____ contract holder ____ third party
If the dealer or third party, what is the preferred method of payment? ____ check ___ credit card
If credit card, what is the fax number?
Name of person to whom to direct the fax:
By my signature below, I certify that the above stated cause of damage is true and accurate. Failure to give
an accurate statement of loss or knowingly submitting false or misleading information will be deemed to be
fraud and may face criminal penalties in accordance with state law.
Repair Facility Printed Name Repair Facility Signature
This form, along with a customer signed RO, should be submitted to IAS. If a third party performed any of the work, a
copy of the sublet invoice should be included as well. Completed documents can be scanned and emailed
to: claimssupport@iasdirect.com
.
If scanning is not an option available to you, you may submit the documents via fax to 512-421-8991 or mail to:
Innovative Aftermarket Systems, L.P.
Attn: Claims Department
10800 Pecan Park Blvd., Ste. 410
Austin, TX 78750
Submitting this form does not ensure that all work claimed will be authorized for reimbursement. You will receive a phone
call with a claim decision as soon as our offices reopen. All claim forms will be processed in the order received. You can
check back to www.iasdirect.com
for updates on the status of the IAS Claims Department.
