In order to prepare the Claim Form so that you can download and print it with the bar code needed for us to process it, please fill out the form below and click Submit. This is a large file and might take a few minutes.
Once your personalized Claim Form has been generated and you have printed it out, you must mail the completed form to the address listed on the printed Claim Form.
Acrobat Reader is Required to download the Claim Form which will be in PDF format. You may already have the Adobe Acrobat Reader on your computer or on disks that came with your computer. If you do, you won't need to download Adobe Acrobat.
If you do not have Acrobat, please click here to download the Free Adobe Acrobat Reader.