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.

Description of problem including part number and serial number of part or component if applicable.	Estimated Hours	Hourly Rate	Excellance Authorization

Warranty Claim Number:

Date Claim Received:


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