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*
MM slash DD slash YYYY
Date of Claim Repair
MM slash DD slash YYYY
Date Claim was Filed*
MM slash DD slash YYYY
Part #*
Mileage
Truck Brand
Model
Description 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, Max. file size: 8 MB, Max. files: 5.
If Claim is Approved
- Credit Requested
- Replacement Requested
Qty Replaced*
L/R or Pair*
If Replacement Requested, Ship to Retailer filing the claim?
- Yes
- No
Recipient Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*

If Claim is Approved