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Get Delco Remy Warranty Claim Form

Date the claim is submitted. The Warranty Claim Form must be completed in full detail for each warranted unit. Warranty Claim Form CLAIM NUMBER CLAIM DATE Must be unique to each claim. Cannot use same number more than once. One claim form should be submitted for each unit returned. A copy of each claim form as well as a copy of the Bill of Lading should be retained for your records. REMY CUSTOMER / DISTRIBUTOR INFORMATION Your company information. Account No Your Remy Account Number Name Address City/State/Zip Country Email Telephone Fax FAILED PART INFORMATION Failed Part No Model/Series Part number of the unit removed. Serial Number Type of unit 21SI 42MT etc. Vehicle In Service Date Example 08B16 Failure Date Date vehicle went into service Date unit removed Product In Service Date Date product went into service if same as vehicle enter same Vehicle/Equipment Make VIN Vehicle Identification Number Replacement Part Number Vehicle Mileage Specify miles kilometers or hours and units Part number of unit being installed Warranty Type Original Equipment New Service or Remanufactured REASON FOR REPAIR / REPLACEMENT Reason unit is being removed- PLEASE BE AS SPECIFIC AND DETAILED AS POSSIBLE CLAIM AMOUNT Parts Misc Charges Remy invoice price of the replacement part plus a 20 handling allowance. One claim form should be submitted for each unit returned* A copy of each claim form as well as a copy of the Bill of Lading should be retained for your records. REMY CUSTOMER / DISTRIBUTOR INFORMATION Your company information* Account No Your Remy Account Number Name Address City/State/Zip Country Email Telephone Fax FAILED PART INFORMATION Failed Part No Model/Series Part number of the unit removed* Serial Number Type of unit 21SI 42MT etc* Vehicle In Service Date Example 08B16 Failure Date Date vehicle went into service Date unit removed Product In Service Date Date product went into service if same as vehicle enter same Vehicle/Equipment Make VIN Vehicle Identification Number Replacement Part Number Vehicle Mileage Specify miles kilometers or hours and units Part number of unit being installed Warranty Type Original Equipment New Service or Remanufactured REASON FOR REPAIR / REPLACEMENT Reason unit is being removed- PLEASE BE AS SPECIFIC AND DETAILED AS POSSIBLE CLAIM AMOUNT Parts Misc Charges Remy invoice price of the replacement part plus a 20 handling allowance. Core Request Any additional charges expected* Total amount for core reimbursement. Total Claim Request Total amount expected for warranty claim* Explanation of miscellaneous charges. Please check this box if the claim is denied and you would like to have the unit returned to you. MUST PROVIDE SHIPPING AUTHORIZATION shipper and account FREIGHT SHIPPING INFORMATION Remy pays the freight for warranty returns incoming to the Reliability Center. Please use the following information when returning warranty units. Freight 0-150 pounds UPS Account No* 355-924 Freight over 150 pounds Contact ProTrans at 888-747-7369 or 317-240-0185. .

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