JX Warranty Claim Form JX Warranty Claim Form-2017-R2 JX Warranty Claim Form "*" indicates required fields FacebookThis field is for validation purposes and should be left unchanged.Customer InformationSponsoring Branch*Fleet Name*Account Number*Fleet Contact Name*Phone*Email* Vehicle InformationWork Order/ RO#*Date of Failure* Make*Mileage @ Time of Failure*Vehicle Serial Number*ComplaintCauseInvestigationCorrectionClaim InformationTotal Repair Hours ClaimedLabor Rate per/hrPartsNumberDescriptionQtyPrice Ea.Total Add RemoveSublet Invoice InfoParts$ Amt (USD)Description Add RemoveTotal LaborTotal PartsTotal SubletClaim TotalAttach Supporting FilesFile Drop files here or Select files Accepted file types: pdf, docx, jpg, png, doc, gif, Max. file size: 200 MB, Max. files: 10. SignatureSMS Policy I agree to the privacy policy. I consent to receive SMS from JX Enterprises, Inc. You may receive text messages related to orders, deliveries, repair status, and general inquiries. Reply STOP to opt-out; Reply HELP for assistance; Message and data rates apply; Messaging frequency may vary. For full Privacy Policy and Terms of Use please visit https://jxtruckcenter.com/privacy-policy. By submitting this form, you consent to JX Enterprises contacting you via phone, or email.
