Warranty Claim Form

All Warranties must fill out this form completely. If claim is requesting Labor reimbursement, please give the customer a replacement product immediately. Validation of labor claim will be processed ASAP after inspection of product. ProVantage warranty does not cover more than 2 injectors per engine. Please do not send back an entire set of injectors. If more than 2 injectors are returned they will be cleaned and repackaged and returned to you.

Submit a printed copy of this form when returning product for warranty. Any product received without proper documentation may be denied warranty.

Complete all forms in English.
Today's Date*

MonthDayYear
Date
Dist Account #*
Distributor Email*
example@example.com
Distributor Phone #*
Phone #
Distributor Info*

Company Name

Street Address

CityState / Province

Postal / Zip Code
Dealer Email*
example@example.com
Dealer Phone #*
Phone #
Dealer Info*

Dealer Name

Street Address

CityState / Province

Postal / Zip Code
Installer Email*
example@example.com
Installer Phone #*
Phone #
Installer Info*

Installer Name

Street Address

CityState / Province

Postal / Zip Code
Part Number*
Quantity*
Engine Serial #*
Product Serial # if applicable
Miles/Hrs*
Claim Preparer
Date Installed*

MonthDayYear
Date
Date Removed*

MonthDayYear
Date
Reason for Return*
If you are requesting Labor reimbursement you MUST include the following to be considered.

Diagnostic reportCopy of the Repair Order (must be included in shipment)
Should be Empty: