CONQUEROR 4X4 PTY LTD
Warranty Claim Form
Customer Information
Customer Name
*
First Name
Last Name
Customer E-mail Address
*
Example: john.smith@myemail.com
Customer Phone Number
*
Example: 0423 456 789
Format: (0400) 000 000.
If the customer is a company, please provide the following Company information:
Company Name, i.e. John's Enterprises Pty Ltd
Company ACN
Customer Address
*
Street Address - Line 1
Street Address - Line 2
Suburb
State
Post Code
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Conqueror Vehicle Information
Conqueror Model Name
*
Please Select
UEV-440
UEV-490
UEV-570
UEV-600
UEV-14
VIN
*
Registration Number
*
Registration State
*
Please Select
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
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Supplier Information
Supplier Name & Location
*
Please Select
Conqueror Off Road Perth
Conqueror Off Road Gold Coast
Conqueror Off Road Sunshine Coast
Conqueror Off Road Darwin
BOLD Caravan and Trailer Repairs Miranda
Claim Submission Date
*
-
Day
-
Month
Year
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Supplier Contact Name
*
First Name
Last Name
Supplier Contact E-mail Address
*
Example: john.smith@myemail.com
Supplier Contact Phone Number
*
Example: 0423 456 789
Format: (0400) 000 000.
Complaint
What is the complaint from the customer?
Cause
What is the diagnosed cause of the complaint?
Correction
What is the proposed repair required to rectify the complaint?
Image Upload
Browse Files
Drag and drop files here
Choose a file
Upload up to 10 files related to the claim (images, reports, etc.)
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Quote Upload
Browse Files
Drag and drop files here
Choose a file
Upload a quote detailing the total cost to carry out the repair (i.e. the value of the claim).
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Submit Warranty Claim Form
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