Good Faith Submission GOOD FAITH REQUEST FORM PRIORITY CODE (Required) * 1 2 3 Date AGENT/AGENCY CLIENT INFORMATION Client (Dealership, etc) CONTRACT HOLDER Contract Holder Name (Required) * Contract Holder Name (Required) First First Last Last Contract Number (Required) * Claim Number (Required) * Amount of Claim Good Faith Amount Requested (Required) * Amount Approved Amount from Customer (If applicable) GF PARAMETERS If GF gesture does not go to RF state who is to be reimbursed—client or contract holder. Upload POP receipts below. Reimburse Client Contract Holder REQUIRED DOCUMENTS UPLOAD DOCUMENTS HERE File Upload Drop a file here or click to upload Choose File Maximum file size: 10MB All Approved GF Gestures Valid for 90 Days Only. If you are human, leave this field blank. Submit
