Sears Protection Agreements: Food Loss
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Customer Information

Please verify your address and contact information.

* First Name:
* Last Name:
* Address 1:
   Address 2:
* City:
* State:
* Zip/Postal Code:
* Primary Phone #:
   Secondary Phone #:
* E-mail Address:

Service Information

Please enter your service and food loss details below to submit your food loss claim.

* Service Date:   What's this?
* Unit #:   What's this?
* Service Order #:   What's this?
* Eligible Product Type:
* Agreement Type:

Itemized Food Loss

How many food items would you like to claim?  

Instructions:
Please enter the food items that you would like to claim. Then enter how many of each item you have in the "Qty" field and how much each item is individually worth in the "Unit Value" field.


Item Description Qty Unit Value
Ex. Frozen Pizza 4 $5.99
1

Receipt Upload (optional):