Warranty Request Form:

Please fill out this form to complete a warranty request and we will respond to you as soon as possible.

Name *

Email *

Original Invoice #

Purchase Date

Failure Date

Vehicle Year

Vin Number

Phone

Part Number

Install Miles

Failure Miles

Vehicle Model

Engine Type

Customer RGA #

Manufacturer RGA #

Comments

When Symptoms Occur

Fault Codes

Claim Verification results from service tech

Action taken by service tech