Warranty Claim Submission A warranty claim must be submitted by a dealer representative.Retailer Name*Retailer Location* Street Address City State / Province / Region ZIP / Postal Code Warranty Contact Name* First Last Suffix Contact Email* Contact Phone*Customer Name*Install Date* Date Format: MM slash DD slash YYYY Date of Claim Repair Date Format: MM slash DD slash YYYY Date Claim was Filed* Date Format: MM slash DD slash YYYY Part #*MileageTruck BrandModelDescription of Issue*Original Invoice #*Picture Upload*At least one picture of the defect and one picture of the whole assembly. Drop files here or Accepted file types: jpg, png, gif. If Claim is ApprovedCredit RequestedReplacement RequestedQty Replaced*L/R or Pair*LeftRightPairIf Replacement Requested, Ship to Retailer filing the claim?YesNoRecipient Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*