Warranty Claim

WARRANTY CLAIM

Customer Information

Company Name *

Street Address *

City *

Province *

Postal Code *

Country

First Name *

Last Name *

Phone *

Email Address *If you are a customer, enter in your e-mail address. If you are a dealer, enter in the dealer e-mail address. This e-mail address will be used for all communication regarding this submission.

Vehicle Information

Type *

Year *

Make *

Model *

Vehicle Identification Number (VIN) *

Engine Model *

Engine Serial Number

Hours of Use

Hours of UseActualEstimate

Product Date Code

Install Date *

Month

Day

Year

Install Km's *

Failure Date *

Month

Day

Year

Failure Km's *

Date of Claim *

Problem Description

Check the item(s) that most nearly describe the reported problem *

Name of defective unitie: fuel injector

Part Number of defective unit

Check the item(s) that most nearly describe the reported problem *Low PowerExcessive Black SmokeExcessive Oil ConsumptionExcessive Coolant LossWill Not Low Idle -- StallsExcessive Fuel ConsumptionNoisy PumpEngine RoughImproper supply Pump PressureFuel LeakLube Oil DilutionCoolant System PressurizingOther

Please Describe the Checked Option(s) *

Description of Problem and Action Taken. If parts were installed, identify below. *

Additional Comments

Diagnostic Trouble Codes

Attach Supporting Documentation

Upload: Invoice, Repair Invoice, ECM Download

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Please do not fill in this field.

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