Dealer & Distributor Warranty Registration

Dealer & Distributor Warranty Registration


 

Thank you for your business. By filling in the form below, you will activate the warranty for your customer’s purchased product. Confirm with your customer that s/he has registered the product for warranty. Please fill in all the compulsory fields in the form completely. Compulsory fields are marked with a red asterisk

General Information

Date:

Product Model:

Kit Front VIN #:

Purchased Date:

Kit Rear VIN #:

Purchased Store Address:

Installer Name:

Purchased Store Name:

Installer Phone #:

Purchased Store Phone #:

Installer Address:

Description of problem and condition:

Car Information

Manufacturer:

Model:

Year:

Type:

Weight:

Engine Poer:

Weight Balance:

Tire Name:

Front Tire Size:

Rear Tire Size:

If car is not stock, please give us detail information:

Customer Information

First Name:

Last Name:

Address:

Phone:

Cell Phone:

Email Address:

Work Phone #:

Credit Card Information

First Name:

Last Name:

Shipping Address:

Billing Address:

Card Type:

Card Number:

Expiry Date:

Security #:

Verification Code:
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Read the agreement Here I have read and agree the agreement