GAP BENEFIT REQUEST SUBMISSION FORM

Submit your GAP benefit request online by completing the form below.
Listed below are the required documents to process your GAP benefit request. If you have any of the documents, please submit them electronically by clicking the Submit Documents Electronically link on the home page.















Required Documents
  • Copy of Finance Contract or Lease Agreement
    May be obtained from the selling dealership or the lending institution.
  • Copy of GAP Waiver
    May be obtained from the selling dealership or the lending institution.
  • Copy of Purchase Agreement or Buyers Order
    May be obtained from the selling dealership or lending institution.
  • Proof of Refund Amounts for any Cancellable Items financed
    such as Vehicle Service Contract, Prepaid Maintenance, Credit Life & Disability, Tire and Wheel Protection, etc. If you financed any of these items, you must contact the selling dealership and request a cancellation refund of these items. The dealership must notify us in writing of the refund amounts.
  • Copy of Loan payment history
    This is obtained from the lending institution, and must be the entire loan payment history from inception to date.
  • Copy of Police Report
    If police report is not available, and cause of loss is NOT due to theft or fire, a signed brief description of the loss will be acceptable.
  • Copy of Vehicle Valuation Report
    This report indicates how the Actual Cash Value of the total loss vehicle was determined. Includes date of loss, type of loss, loss odometer, applicable taxes, tag fees, and deductible amount if applicable.
  • Copy of Primary Insurance Company Settlement Check and Settlement Breakdown
    Breakdown indicates how the settlement payment was calculated.
Click HERE to download the list of all the required documents and how to obtain them.
Please Note:
You must provide the documentation listed above to the GAP Administrator within 90 days of receiving settlement from the Primary Insurance Company and/or when your vehicle was deemed a total loss. The GAP Administrator will not be able to obtain this information for you.