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Warranty Claim Form
Warranty Claim
1
Dealer Information
2
Eligible Vehicle information
3
Service Team Information
4
Documents Upload
Warranty Claim Type
*
please select claim type
MOC® Limited Warranty Repair Request
MOC® Pre-Owned Limited Warranty Indemnification Request
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Date
*
MM slash DD slash YYYY
Dealership Information
Ready Checklist
*
Yes, I have the initial Service Repair Order (reflecting MOC® Eligible Warranty Products) scanned for upload.
*
Bill-of-Sale
*
Yes, I have the Bill-of-Sale (reflecting service using MOC® Warranty Product)
*
*
Yes, I have the Estimate - Service Repair Order scanned for upload
*
Contact Person
*
Phone
*
Email
*
Dealer Name
*
Address
*
City
*
State
*
Zip
*
FAX
Vehicle Information
Vehicle Year
*
Make
*
Model
*
Mileage Upon Initial Service
*
Part Number(s)
*
Initial Service Date
MM slash DD slash YYYY
Current Mileage
*
VIN#
*
Covered Parts
Engine
Fuel
Transmission
Power-steering
Cooling
Indemnified Parts
Engine
Fuel
Transmission
Power-steering
Cooling
Air-Conditioning System
Claim Information
Service Manager Full Name
*
Service Advisor Full Name
*
Service Technician Full Name
*
Description
*
Parts Cost
*
Labor
*
Description
Parts Cost
Labor
Description
Parts Cost
Labor
Description
Parts Cost
Labor
Total Claim Amount
Additional Vehicle Information
You must provide a complete statement of Damage and Repair costs
*
Document Upload
Initial Service Repair Order - File
*
Max. file size: 512 MB.
Estimate Repair Order - File
*
Max. file size: 512 MB.
Bill-of-Sale - File
*
Max. file size: 512 MB.
Consent
*
I acknowledge all provided information is accurate and understand that submission of this online Warranty Claim form is pending approval.
Initials
*
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Upon submission, you will receive an email confirmation. If you do not receive an email within five minutes, please contact our Warranty Department at (818) 795-3500. Thank you kindly, Warranty Support
Phone
This field is for validation purposes and should be left unchanged.
CONTACT US, WE’RE HERE TO HELP!
Send us a message
+1 818 794-3500
info@mocproducts.com
12306 Montague Street. Pacoima CA 91331
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