Warranty Claim Form

Dealer/Service Center Information

*Date

Please enter date.

*Dealer Name

Please enter dealer name.

*Dealer ID/Store #

Please enter dealer id/store #.

*Dealer Email

Please enter dealer email.

*Dealer Physical Address

Please enter dealer physical address.

*Dealer City

Please enter dealer city.

*Dealer State / Province

Please choose dealer state.

*Dealer Zip

Please enter dealer zip.

Customer Information

*Customer Name

Please enter customer name.

*Date of Purchase

Please enter customer date of purchase.

*Customer Phone

Please enter customer phone.

Vehicle Information

*Vehicle Status

Please choose vehicle status.

*Model Year

Please choose customer model year.

*Model Name

Please enter choose model.

*Current Mileage

Please enter current mileage.

*Engine Size

Please enter engine size.

*VIN #

Please enter vin #.

Complaint / Troubleshooting / Repairs

Customer Complaint

Cause & Repair

The Following Documents Must Be Provided For All Claims

Hisun Parts Invoice # (Not your PO Number(Parts Ordered)):

*Invoice #

Please enter engine size.

Copy of VEHICLE INVOICE showing under warranty (if not sold through your dealership)

Pictures of all Parts that would be considered failed under Warranty Policy for Manufacturer Defect.

In addition, if the Claim related to EMISSIONS PERFORMANCE, the following must be provided:

EPA Emission Parts will need to be returned to Hisun Motors.

Parts Used

Part Number	Part Description	QTY	Price	Total
Part Number	Part Description	Quantity	Price	Total
Total Part Cost				Total
*Total Parts 20%**				Total
				Calculate

Labor Used

Flat Rate Number	Job Description	Labor Hours
Flat Rate Number	Job Description	Labor Hours
Total Hours		Total Hours
Dealer Hourly Rate (approved by Hisun)		Hourly Rate
Labor Total (Hours * Hourly Rate)		Labor Total
Warranty Claim Total		Claim Total
		Calculate

By submitting this claim, I hereby certify that the information provided in this claim is true, accurate and complete.