TA ClaimTrak: TA ID/Claim Code Request Form

This form is for Managers and/or other TA customers who do not submit claims directly, and subsequently need a TA ID and/or Claim Code in order to create a TA ClaimTrak account. Call 404-389-4060 for immediate assistance. 

Please ensure person listed has submitted a claim to TA
Any claim number submitted by your company to TA.