Engine Warranty Authorization Form

All mandatory fields are marked with *

Company Name: *
Contact Name: *
Phone: *	Ext:
Fax:
Email: *
Engine S/N: *
GMPT S/N: *
Date Vehicle Sold: *		Hours on Engine:*
Failure Date: *
Equipment Mfr: *
Equipment Model: *
Equipment S/N: *
Dealer Name:
Address:
City:
Zip:
Customer Complaint: *
Fault Codes:*
Cause / Diagnosis:*
Repair Details:*
List Part #'s Used if Any