Part Special


Warranty Claim Application

* = Required Fields


I. COMPANY INFORMATION
Dealer Sponsor Code *
Customer Name *
Company Address *
City * (no abbreviations)
State *
Zip * (i.e. 53242)
Contact Person *
 Phone * (i.e. 414-515-2424)
Email Address: (i.e. bill@somewhere.com)
Company Web Site Address: (i.e. www.somewhere.com)
 
II. VEHICLE INFORMATION
Work Order
Last 6 of Serial Number *
Make *
Model *
Mileage (ex 121,000)*
III. CLAIM INFORMATION
Invoice Number (your RO)*
Date of Failure (Ex mm/dd/yy) *
Failure Location
Labor Codes
Flat Rate Time (Ex 2 hours)
Failure Type
Complaint/Cause/Correction
Parts Used in Repair *
Part #
Part Name
QTY
Each $
Total $

Sublet if applicable Amt:
Description:
Amt:
Description:
Total Parts & Labor Amount Requested (Ex $50.25)
 
Please SHIP FAILED PARTS & INVOICES WITHIN 5 DAYS of Filing the Claim to the appropriate JXE Dealer - Attention:  SERVICE MANAGER
Sending Parts & Invoices to:

PRIVACY STATEMENT
COPYRIGHT STATEMENT
COMPANY CONTACT INFORMATION