online claim form.
Please enter your details as they appear on your 'Fifth Dimension Registration Form'.
( Mandatory fields are marked with an asterix
*
)
Customer Details
Customer registration form No
Please attach your proof of purchase for a faster approval process.(Maximum File Size is 1MB)
Alternatively, please fax your proof of purchase through on 03 9830 2117
Name
*
Mr.
Mrs.
Miss.
Ms.
Dr.
Prof.
Rev.
Address
Suburb
State
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
PostCode
Phone
*
Email
*
Certificate No
(if applicable)
Vehicle Details
Make
*
Select the make
ACE CAMPER TRAILERS
ADRIA
ADVANCE
ALFA ROMEO
ASIA
ASIA MOTORS
ASTON MARTIN
ASTREK
AUDI
AUSSIE SWAG CAMPERS
AUST OFF ROAD CAMPERS
AUSTRALIAN CLASSIC CAR
A'VAN
BEDFORD
BENTLEY
BERTONE
BMW
BOROMA
BUGATTI
BUSHTRACKER
CADILLAC
CAMEL GROUP
CAMERON CANVAS
CAMPOMATIC
CATERHAM
CAVALIER
CHALET CAMPERS
CHEVROLET
CHRYSLER
CITROEN
COACHMEN
COMMODORE
COMPASS
CONCEPT
COROMAL
CORONET
CSV
CUB
DAEWOO
DAIHATSU
DAIMLER
DODGE
DRIFTAWAY
EARTHCRUISER
ECO TOURER
ELFIN
EUNOS
EVERNEW
FERRARI
FIAT
FORD
FORD PERFORMANCE VEHICLES
FREIGHTLINER
FRONTLINE CAMPERS
FSM
FUTURE SYSTEMS
GALAXY
GAZAL
GEIST
GIOCATTOLO
GOLDSTREAM
GOLF
GRANDCRUISER
GREAT WALL
HALLMARK
HARDING
HDT
HEASLIP
HINO
HOLDEN
HOLDEN SPECIAL VEHICLES
HONDA
HORIZON
HUMMER
HYMER
HYUNDAI
INTERNATIONAL
ISUZU
IVECO
JAGUAR
JAYCO
JEEP
KEA
KEDRON
KENWORTH
KIA
KIMBERLEY KAMPERS
LADA
LAMBORGHINI
LAND ROVER
LEXUS
LEYLAND
LINCOLN
LOTUS
LOTUS CARAVANS
M.G.
MACK
MAHINDRA
MAN
MASERATI
MATILDA
MAYBACH
MAZDA
MERCEDES
MERCEDES-BENZ
MILLARD
MINI
MINI MOBILE
MITSUBISHI
MONARCH
MORGAN
NEWLANDS
NISSAN
NOBLE
OKA
OLYMPIC
PAGANI
PALOMINO
PARADISE
PEDIGREE
PEUGEOT
PHOENIX CARAVANS
PORSCHE
PRATTLINE
PREMIER
PROTON
QUEST
REGAL
REGENT
RENAULT
ROADSTAR
ROBNELL
ROLLS ROYCE
ROMA
ROVER
ROYAL FLAIR
SAAB
SCANIA
SCENIC
SEAT
SHIPPSHAPE TENTS
SHIRALEE
SIENNA
SKODA
SMART
SPACELINE
SPRINGVALE
SSANGYONG
STERLING
SUBARU
SUNCAMPER CONVERSIONS
SUNLINER
SUPREME
SUZUKI
SWAGMAN
TATA
TD 2000
TOUGH COUNTRY
TOWTEL
TOYOTA
TRACK
TRAILBLAZERS
TRAKKA
TRAKMASTER
TRAVELLER
TRD
TREK
TRUSTAR
TVAN
TVR
ULTIMATE
VENTURE FIFTH WHEELER
VISCOUNT
VOLKSWAGEN
VOLVO
WAYFARER
WESTERN STAR
WINDSOR
WINNEBAGO
WIRR-AWAY
X STREAM
YORK
Model
*
Rego #
*
Vehicle Year
Chassis #
Application Date
Dealer
*
Colour
Repairs
Please describe the repairs which you would like to claim (Bumper bar, Minor dent, Deep scratches, Stone chip, etc)
Product Fault
*
Select
Tree Sap
Fading
Bird Droppings
Other
Product
Details
Other Comments
*
I agree to the terms of the fifth dimension scratch n Dent safeguard warranty whereby the maximum claimable for an individual claim is $300 and as the owner, I am responsible for the first $30 of any individual claim.