Warranty Claim Form

Dealer/Service Center Information
Please enter date.
Please enter dealer name.
Please enter dealer id/store #.
Please enter dealer email.
Please enter dealer physical address.
Please enter dealer city.
Please choose dealer state.
Please enter dealer zip.
Customer Information
Please enter customer name.
Please enter customer date of purchase.
Please enter customer phone.
Vehicle Information
Please choose vehicle status.
Please choose customer model year.
Please enter choose model.
Please enter current mileage.
Please enter engine size.
Please enter vin #.
Complaint / Troubleshooting / Repairs
The Following Documents Must Be Provided For All Claims
Please enter engine size.
In addition, if the Claim related to EMISSIONS PERFORMANCE, the following must be provided:
Parts Used
Part Number Part Description QTY Price Total
Total Part Cost
Total Parts * 20%
Labor Used
Flat Rate Number Job Description Labor Hours
Total Hours
Dealer Hourly Rate (approved by Hisun)
Labor Total (Hours * Hourly Rate)
Warranty Claim Total
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