WARRANTY REQUEST FOR CREDIT

For more information, please call Heil of Texas at 713-923-7600.

This warranty request is designed to be completed by the applicant and submitted with all the (*) required fields as marked below.

PLEASE FILL THE OWNER INFORMATION OUT BELOW

Distributor Information

Owner Information

Heil of Texas
5900 Wheeler
Houston, TX 77023
Owner:*
Attn:*
Address:*
City, State, Zip:*
Email Address:*
Phone:*

Serial Number:

In Service: Failure Date: Repair Date:

CHASSIS INFORMATION

Body Number:

Make: Model: Engine Hours:

What was the customers complaint? Please be specific.
What did you do to repair the machine? Be specific, (REPAIR AND REPLACE) is not acceptable.
Heil of Texas Invoice Number(s) for parts used in repair: If more than one separate with a comma.
      ($) Credit Requested  
Quantity Heil Part Number Description/Replacement Part Serial Number Each

Total

# $

$

# $

$

# $

$

# $

$

# $

$

# $

$

# $

$

Total Heil Purchased Parts:

$

Total Labor:

$

Total Outside Matl/Parts:

$

Total Freight:

$

CALCULATE CLAIM TOTAL BEFORE HITTING SUBMIT BELOW:

$

ADDITIONAL INFORMATION

SUBMIT WITHIN 14 DAYS FROM DATE REPAIRS COMPLETED. VOID IF NOT RECIEVED WITHIN 60 DAYS.
Please take pictures and email all questionable repairs to warranty@heiloftexas.com, BE SURE to label all emails with the serial # of the truck to ensure the email and claim marry together. Always Hit Calculate Claim Total as the last thing you do before you Submit the Form.
SIGNATURE* DATE*

Please sign and date this form and enter the security code below then hit the submit button.

security code
Enter Security Code: