Warranty -- Excellance, Inc. -- Manufacturers of Quality Emergency Vehicles

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Or Call Excellance at 256 772-9321 if you need assistance completing this form.

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Owner of Unit:
Excellance Unit Number:
Vehicle Mileage
VIN:
Repair / Service Shop:

Shipping Address: (for UPS delivery)
Street
City
State
Zip
Contact Name:
Telephone Number:
Fax Number:

All repair work for which Excellance will be billed must first be authorized by Excellance, Inc. Please be sure that this form is complete, no areas left blank.

Component/Part
Description of part or component
Manufacturer and Part or Model Number
Serial Number
Description of Problem

Component/Part
Description of part or component
Manufacturer and Part or Model Number
Serial Number
Description of Problem

Component/Part
Description of part or component
Manufacturer and Part or Model Number
Serial Number
Description of Problem

Warranty Claim Number:

Date Claim Received:


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