Warranty Filing Request Form
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1WARRANTY FILING REQUEST FORM
CIMC-IE RGA #: _____________________________
CIMC-IE CONTACT: _________________________
CIMC-IE CONTACT EMAIL: ___________________
CIMC-IE CONTACT PHONE: __________________
VEHICLE INFORMATION
VEHICLE MANUFACTURER: IN-SERVICE DATE
(MM / DD / YYYY): ___________________
VEHICLE MODEL ________________________
VEHICLE IDENTIFICATION NUMBER (VIN):
__________________________________________
LOCATION: _____________________________________________
VEHICLE OWNER/FLEET NAME: _________________________ CONTACT NAME: _______________________
VEHICLE OWNER UNIT NUMBER: _______________________ CONTACT NUMBER: _____________________
For Warranty Claims, please do the following:
1. Click the “DOWNLOAD” button to save a PDF copy to your computer.
2. Once downloaded, reopen the same PDF and enter warranty filing information in the fillable fields.
3. Click the “SAVE” button to resave the PDF to your computer.
4. Email the PDF to .
5. Click “PRINT” to print a copy.
Refer to CIMC-IE Warranty Statements for definition of coverage, exclusions and limitations.
COMPONENT INFORMATION
(EX: LOCATED ON I.D. TAG, Stamped on Frame Etc)
COMPONENT PART NUMBER: __________________ COMPONENT SERIAL NUMBER: _________________
REPAIR INFORMATION
CONTACT NAME: ______________________________ PHONE NUMBER: ____________________________
EMAIL: _______________________________________
WORK ORDER NUMBER: _______________________ COST OF REPAIR: ____________________________
FAILURE DATE: (MM / DD / YYYY): ______________________
DESCRIPTION OF OCCURRENCE / FAILURE
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
**
PLEASE MAKE EVERY EFFORT TO HOLD THE SUSPECT PARTS UNTIL RECEIVING DIRECTION FROM
**
CIMC-IE/ CIMC, or Manufacture of Component
DIGITAL PICTURES
AVAILABLE:
NO/ YES (IF YES, PLEASE ATTACH TO EMAIL WITH THIS FORM)
COPY OF WORK ORDER
AVAILABLE: NO/ YES (IF YES, PLEASE ATTACH TO EMAIL WITH THIS FORM)
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34 Three Creek Drive
Emporia, VA 23847
USA
Phone
: 434 - 634 - 3433
Fax: 434 - 634 - 3440
CIMC-IE Warranty
Please email completed form to the following email address:
CIMC-IE-WR-Form-6-1-2014
Submit
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Parent category: Legal