Parts Warranty Claim Form


Work Order / RO #:		Mileage @ Time of Failure:
Date of Failure:		Serial Number:
Make:		(Last 6 Digits of Vehicle Serial Number)

Complaint (What doesn't work?)

Cause (What was failed that caused the complaint?)

Investigation (How was the cause found?)

Correction (What was done to repair the cause after the investigation was done?)


Total Repair Hours Claimed:		Labor Rate P/hr:

Part Number	Part Description		Qty	Price Ea.	Total









Sublet Invoice Info				Total Labor:
Amount	Description			Total Parts:
				Sublet
				Claim Total:
Please return all failed parts along with purchase invoices to sponsoring dealer

* = Required Field
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