Warranty Claim Form Warranty Claim Form SERVICE CENTER Warranty Claim Form Each section of the Warranty Claim Form is broken down below to show your progress through the claim submission. Please complete all 6 sections before you submit. Thank you. 1Dealer Information2Customer Information3Truck Information4Warranty Claim Information5Repair Information6Attachments CommentsThis field is for validation purposes and should be left unchanged.Dealer InformationDealer Name(Required)Please select your dealershipApgar AmbulanceAutotronicsBulldog Fire ApparatusCastle Emergency VehiclesDankoEmergency Equipment ProfessionalsFirst Priority GroupGlick Fire Equipment CompanyKodiak Emergency VehiclesNorth Central Emergency VehiclesNorth Eastern Rescue VehiclesMacQueenPenn CarePinnacle Emergency VehiclesProLiner RescueRedSky Emergency VehiclesSiddons-Martin Emergency GroupSpartan Fire & Emergency ApparatusTen-8 Fire & SafetyTrue North Emergency EquipmentDealer Email(Required) Dealer Address(Required)Please add in the address of your facility where the service work was performed. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Payment Address(Required)Please add in the address of your facility you would like your payment to be sent. Same information as the Dealer Address above. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Customer InformationCustomer Name(Required)Customer Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Truck InformationBraun 4 Digit ID(Required)VIN(Required)Mileage(Required)Delivery Date(Required) MM slash DD slash YYYY Warranty Claim InformationDate of Claim Submission(Required) MM slash DD slash YYYY Date of Customer Complaint(Required) MM slash DD slash YYYY Date of Service Performed(Required) MM slash DD slash YYYY Preauthorization NumberTotal Number of Repairs Being Submitted(Required) Repair & Parts InformationIn this section, you will provide the repairs and parts related to your claim. The number of items you add will vary based on your issue(s). Therefore, when you are done adding your applicable repairs and parts, please scroll down and click NEXT to move on to the final step. Thank you! Repair InformationPlease start by clicking Add Repair to provide details on your first repair. Select Add Repair again for each additional repair you wish to report. Repair # Problem Description Problem Cause Problem Remedy Labor Hours Being Requested Actions Edit Delete There are no Repairs. Add Repair Maximum number of repairs reached. Parts InformationPlease start by clicking Add Part to provide details on your first part. Select Add Part again for each additional part you wish to report. If there were no parts utilized, please skip this section. Please indicate the repair # where this part was use. Repair # Part Number Part Description Part Price Actions Edit Delete There are no Parts. Add Part Maximum number of parts reached. AttachmentsPlease attach sublet bills, photos, and any other related items here. We will accept .png, .jpg, .pdf files only. You can upload up to 10 MB worth of data. If you have more than that, please upload your files to Box and send them to us separately Drop files here or Select files Accepted file types: png, jpg, jpeg, pdf, Max. file size: 10 MB. CAPTCHA