Warranty Request Form

Sale Info

INVOICE INFORMATION

Original Invoice Number

Original Sale Date

Complaint Date

Contact Info

CONTACT INFORMATION

Company Name

Contact Name

Phone Number

Address Line 1

Address Line 2

City

State

Zip Code

Vehicle Info

VEHICLE INFORMATION

Vehicle Type

Model

Engine Mfg.

Engine Serial Number

Failed Item PN

Description

Date of Installation

Miles at Date of Installation

Installer

Owner

Date of Failure

Miles of Failure

Original part failure prior to part installation:

Lists Parts Replaced

Description of Complaint

Engine Operation Prior to Failure

Off Road or Highway

Core Returned?

Core Credit Received?

River City Truck Parts Inc., along with its Vendors, has Full and SOLE authority on ALL Warranty Claims. ALL DETERMINATIONS ARE FINAL.

I agree

Date

Warranty Request Form