Wheel Well Tire Scuff Block Modification - Up-113

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Warranty claim form F-5.03
Rev. : 1
Demers, Ambulances Manufacturer Inc. (West)
303 Jessop Avenue Saskatoon, SK, S7N 1Y5 Tel.: 306-373-4464 Fax: 306-373-4144
or Head Office:28 Richelieu, Beloeil, QC, J3G 4N5 Tel.: 450-467-4683 Fax: 450-467-6526
1 Vehicle serial number (V.I.N) (Number on dash, driver’s side)
2 Fleet unit number 3 Demers stock number
4 Date in service (YY/MM/DD) 5 Milles / Miles
6 Date of failure (YY/MM/DD) 7 Date of warranty claim
8 Description of the issue
9 Cause(s) of the issue
10 Corrective(s) action(s)
11 Estimated repair time
12 Claim requested by 13 Invoice N°
14 Billing address 15 Shipping address
Phone: Phone:
Part N° QTY DESCRIPTION
DEMERS RESERVED SECTION
1. Warranty claim authorization no. :
2. Time allowed for repairs :
3. Warranty claim authorization date :