Warranty Request Form - River City Truck Parts

Original Invoice Number *

Original Sale Date *

Complaint Date *

Phone Number *

Company Name *

Contact Name *

First

Last

Email *

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

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. *

Date *

Comment