Warranty Pre-Authorization Request

Warranty Pre-Authorization Request
111 East Innovation Blvd Syracuse, IN 46567 P: (574) 457-3924 Ext-123 Email: Warranty@tlrvs.com

Warranty Authorization Request
Dealer Name
Dealer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dealer Work Order #
Unit Vin#
Requestor/Dealer Email
example@example.com
Requestor Name
Retail Sold
Date Requested:

MonthDayYear
Date
Requestor/Dealer Phone #
Please enter a valid phone number.
Flat Rate Code
Fault Code
Describe Problem
Describe Cause
Describe Remedy
Replacement Part Required:
Hours Requested
Flat Rate Code
Fault Code
Describe Problem
Describe Cause
Describe Remedy
Replacement Part Required:
Hours Requested
Flat Rate Code
Fault Code
Describe Problem
Describe Cause
Describe Remedy
Replacement Part Required:
Hours Requested
Flat Rate Code
Fault Code
Describe Problem
Describe Cause
Describe Remedy
Replacement Part Required:
Hours Requested
Total Hours Requested
Labor Rate
Total Amount Requested
Should be Empty: