Please fill out and submit the form below. After submitting this form, you will receive a confirmation email with your claim number and information.
If we require more information to submit your claim, a claims representative will be in contact with you.

In the "What happened?" section, please include all details of the incident (if available) including:

  • Type of damage (mechanical, body, etc)
  • The current location of the equipment

Name
*
Email
*
Address1
*
Address2

City
*
State
*
Zip
*
Phone
*
KCC Loan or EPD Policy #
When Did the Damage Occur?
Date
Time
What Equipment was damaged? (please provide make/model/serial # if available)
What happened?
Transportation Requirements:
Kubota Dealer/Repair Facility you plan to use: