Automotive Parts Warranty Authorization Document
Customer Information
Name
Phone
Email
Address
Vehicle Information
Make
Model
Year
VIN
License Plate
Part Information
Part Name
Part Number
Description of Issue
Warranty Authorization
Date of Installation
Date of Failure
Odometer at Installation
Odometer at Failure
Action to be Taken / Authorization Reference
Authorized By (Print Name & Signature)
Date
Customer Signature
Date