TEMSA Warranty Claim Form

TEMSA Warranty Claim Form
Source
Please fill out this section if you are a Temsa CSR or Temsa Service Provider
Temsa CSR or Service Provider Name
Please fill out if you are a Temsa CSR or Service Provider
Temsa CSR / Service Provider Email
example@example.com
Customer Contact Information
Account Number
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vehicle Information
Model*

TS30TS35TS45TS45 EV
VIN#*
Mileage*
Warranty Information
Notice:

CLAIM MUST BE SUBMITTED WITHIN 30 DAYS OF FAILURE OR THE CLAIM WILL BE AUTOMATICALLY REJECTED. Please consult the Temsa Warranty Manual for warranty coverage provisions. Free shipping is included for 2nd day air requests and for ground shipping only. Next Day shipping requests will be charged to the customer's parts account or must be paid with credit card. To contact a warranty administrator, call 1.833.628.3672 (ext.114)
Complaint*
File Upload for the complaint*

Cancelof
Component Part and Serial Number (if any)
Date of Compaint*

MonthDayYear
Date
Bus Down due to Problem?*

YesNo
Cause (if known)
Correction (if any)
Request / Comments*
Requested Parts (if any)

Customer Contact Information