Hurricane Ian Buyer Assurance Program

Print claim form

Once you’ve provided claim form information, bring it to your local participating dealer, along with the required documentation listed below. Be sure to make a copy of your paperwork for your records.

Required documentation
 

1. Claim Form/Incentive Worksheet
All fields must be completed. Coupon must be signed by the customer and an authorized dealership signatory.
 

2. Official Signed Purchase/Lease Agreement

a) Disaster Relief Program amount must be listed as a separate line item. The Rebate Breakdown Form may be used if the dealer is not able to breakdown the rebate amount on the Purchase/Lease Agreement.

b) Buyer/Lease Orders will only be accepted if the rebate is clearly included in the final amount financed or the final amount due by the customer.
 

3. A letter on insurance company’s letterhead or a copy of the completed vehicle insurance claim form. The letter or claim form must clearly identify the customer name, vehicle make and model, the amount of damage on the vehicle and proof of damage from the recent severe weather conditions of Hurricane Ian. Insurance claims must show damage occurred during Hurricane Ian on or after September 28, 2022.
 

4. If the purchaser is not the listed owner on the insurance letter or insurance claim form, please provide a copy of the driver’s license of both the purchaser and the listed owner to prove same residency.
 

All claims must be submitted to a participating dealership for payment by claim processing deadline.
 

IMPORTANT: Disaster Relief Coupon incentive amounts are subject to change without notice. HMA reserves the sole right to cancel, amend or revoke any incentive program in full or in part for any reason at any time without incurring liability. HMA reserves the sole right to interpret these rules and shall not be bound by any previous interpretations made by HMA before or during the program. If you have any questions or require additional information, please contact your regional office.