KrexInc.com

Rental Reimbursement Form

Information required:

Customer name, address and day & evening phone numbers.
Original, DATED Road Service Receipt.
Photocopy of service invoice from dealership.
A photocopy of the receipt for the rental car, and a copy of the service invoice for the repair of the mechanical problem that caused the breakdown.

Please include the documents listed above and mail within 30 days of the incident to:

Krex, Inc.
Attn: Reimbursement Dept.
450 Skokie Blvd., Bldg. 200
Northbrook, IL 60062

You may also submit your rental reimbursement claim online by completing the form below.

* fields are required.
Name :	*
Address :	*
Suite/Apt :
City :	*
State :	*
Zip Code :	*
Home Phone :	*
Work Phone :
E-mail :	*
I am submitting my reimbursement information as follows : (All files must be either jpg, tiff or pdf. Each file cannot be greater than 500 KB.)
Roadside Assistance Service Receipt :	*
Qualifying Service Receipt from Dealership :	*
Rental Vehicle Receipt :	*
Service Receipt from Dealership for Mechanical Repair :	*