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Warranty Claim Form
Ashley Guthrie
2021-02-19T19:37:21-06:00
JX Warranty Claim Form
JX Warranty Claim Form-2017-R2
Customer Information
Sponsoring Branch
*
Fleet Name
*
Acct Number
*
Fleet Contact Name
*
Phone
*
Email
*
Vehicle Information
Work Order/RO#
*
Date of Failure
*
Date Format: MM slash DD slash YYYY
Make
*
Mileage @ Time of Failure
*
Vehicle Serial Number
*
Complaint
Cause
Investigation
Correction
Claim Information
Total Repair Hours Claimed
Labor Rate per/hr
Parts
Number
Description
Qty
Price Ea.
Total
Sublet Invoice Info
List
$ Amt (USD)
Description
Total Labor
Total Parts
Total Sublet
Claim Total
Attach Supporting Files
Drop files here or
Accepted file types: pdf, docx, jpg, png, doc, gif.
Signature
*
Email
*
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