Warranty Claim Form
Company Name
*
Name of Business Conducting Assessment
Your Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Fleet Vehicle Number or Job Number: (FVxxxxx/JNxxxx)
*
Product at fault (Record Serial Number featured on sticker) E.g. Battery Box BB2024002-AEP
Describe The Issue In Detail:
*
Registration Plate Information:
*
Vehicle Odometer:
*
Date Last Serviced:
-
Day
-
Month
Year
Date
Last Service Date Odometer Reading:
Upload images of issue to be assessed THIS IS MANDATORY, CLAIM WILL NOT BE PROCESSED WITHOUT THESE PHOTOS
*
Browse Files
Drag and drop files here
Choose a file
Please Ensure you upload images of the Odometer the claim will not continue until it is supplied.
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