MACH1/ROOST - Warranty Submission
Date
-
Month
-
Day
Year
Date
Purchase Date & Dealer Name
*
Image - Proof of Purchase
*
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of
Submission Type
Filled out by customer
Filled out by dealer
Name
*
Contact Phone
*
Contact Email
Vehicle Model
*
Damaged Area
*
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of
Mounting Point #1
*
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of
Mounting Point #2
*
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of
Mounting Point #3
*
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of
Vehicle Image #4
*
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of
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Issue and Concerns
Shipping Address for Parts
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Need by Date
-
Month
-
Day
Year
Date
Comments
Submit
Should be Empty: