Warranty Claim.

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Distributor Contact Info

Name*

Address*

Distributor Email*

Unit Owner Contact Info

Name*

Email*

Phone*

Company Name*

Company Address*

Failed Unit Information

Repair and Return Needed?*

Replacement Needed?*

Failed Date*

Part Type*

Serial #*

Model #*

P.O. #*

Where is the truck located?*

Reported Complaint*

Labor Estimates

Labor Cost for R&R Unit

Estimated Hours

Labor Rate

(Labor is subject to approval by Valley Truck Parts Warranty Dept.)

Is towing required?*

Tow Bill Cost

Vehicle Information

Vehicle Make / Model*

VIN*

Mileage at Install*

Mileage at Failure*

Truck Equipment Use*

Supporting Documents

Document

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Comments

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NEED SOMETHING ELSE?

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