KSAP Labor Claim Request Form

Required fields indicated with *

Salesperson

Warehouse

Date *

Customer *

Contact *

Address

Acct#

Phone# *

City

State

Zip

Fax#

E-mail Address *

Labor Rate Per Hour: $ *

VEHICLE INFORMATION:

Year *

Make *

Model *

VIN# *

Engine Displacement *

Auto/Manual Trans *

2WD/4WD/AWD *

Mileage At First Repair *

Date of First Repair *

Mileage At Second Repair *

Date of Second Repair *

Mileage At Third Repair

Date of Third Repair

Original Tech`s Name *

FAILED PART:

Manufacturer *

Part# *

Associated Parts

Description Of Failure (Required)

REQUIRED COPIES:

Original RO

Repair RO

Tow Bill

Disclaimer

* Please note, to be considered for a labor claim, a customer must average $1500 in monthly purchases.

** Customer account must be in good standing.

To prove you are a human, please tell us which is slow?