File a Claim Form Your InformationName(Required) First Last Email(Required) Enter Email Confirm Email Phone(Required)Purchase DetailsDate of Purchase(Required) MM slash DD slash YYYY Invoice / Contract NumberIf knownPuppy DetailsPuppy Name(Required)Puppy Breed(Required)Puppy Sex Male Female Puppy Date of Birth MM slash DD slash YYYY Microchip NumberAKC / Registration NumberTrupanion ClaimTrupanion Policy / Member Number(Required)Trupanion Claim Number(Required)Date of Vet Service(Required) MM slash DD slash YYYY Veterinary Clinic NameReimbursement AmountsEnter these from your Trupanion Explanation of Benefits (EOB).Total Vet Bill(Required)Amount Trupanion Paid(Required)Your Deductible(Required)Your 10% Co-pay(Required)Total Reimbursement RequestedAutomatically calculated: your deductible + your 10% co-pay.Upload DocumentsAccepted files: jpg, png, pdf (max 20 MB each).Itemized Veterinary Invoice(Required)Accepted file types: jpg, png, pdf, Max. file size: 20 MB. Trupanion Explanation of Benefits (EOB)(Required)Accepted file types: jpg, png, pdf, Max. file size: 20 MB. Proof of Payment (receipt or statement)(Required)Accepted file types: jpg, png, pdf, Max. file size: 20 MB. Confirm & SubmitAuthorization(Required) I authorize The Puppy Store Las Vegas to verify these amounts with Trupanion if needed. Certification(Required) I certify the information provided is accurate and complete. Signature(Required)Type your full name as your signature.
