This form is intended for use by licensed repair facilities wishing to submit a claim to Ford Extended Service Contract. By submitting this form, you agree that the information provided is true and accurate.
This form is NOT intended for the following:
• General coverage inquiries
• Facilities located outside of the USA
• Customer refunds (for repairs already completed)
• Ford or Lincoln Franchised Dealers or Participating Franchised Dealers with a Parts and Accessory Code (PA Code)
• Customer or vehicle owner inquiries
• Claim status inquiries (for claims already submitted)
• SurfaceCare, DentCare, WindshieldCare, TrippleCare, EtchCare, TirecCare, or Keyservice Claims

If you require assistance with any of the above items or you are inquiring about the status of a claim already submitted do not proceed with this form. Please contact Ford Extended Service by phone at (800)-521-4116.