Applied Underwriting Claims Report
| Dealer Number | Contract Number | Sales Date | Deductible | Plan | Claim Number | Damage / Failure Date | Claim Date | Payment Date | Total Paid |
|---|---|---|---|---|---|---|---|---|---|
| Dealer Number | Contract Number | Sales Date | Deductible | Plan | Claim Number | Damage / Failure Date | Claim Date | Payment Date | Total Paid |
