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Warranty Claim Form
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>
Warranty Claim Form
"
*
" indicates required fields
BODY / VEHICLE INFORMATION
VIN or Key # (last9):
*
Serial # :
*
In Service Date:
*
DD slash MM slash YYYY
Request Date:
*
DD slash MM slash YYYY
DISTRIBUTOR OR END USER INFORMATION
Company:
*
Contact name:
*
Phone
*
Email:
*
Invoice/WorkOrder #:
Location or address of vehicle/body:
Description of the problem / Attach Repair Estimate
Will this require pickup/delivery by Duramag?
Yes
No
Onsite repair
Will you need:
Parts only
Repair labor only
Parts & repair labor
Will you be doing the repairs?
Yes
No
Need a repair appointment set up for you?
Yes
No
CUSTOMER REPRESENTATIVE INFORMATION
Person filing claim:
Dealership:
Email:
*
Phone
*
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