Warranty Claims Clean-up Request Form

For assistance with completing this form

> Call: 1.800.852.6298
> Email: customer service

Warranty Claims Clean-up - Request Form

J&L Warranty Pros' Warranty Claims Clean-up service is just 10% of paid claims plus a $250 startup fee to cover the costs of setting up the account. Complete this form and J&L will contact you soon to get started!

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1. Please select your franchise:
GM Chrysler Ford

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2. Contact information
* First Name:	* Last Name:
Title:	Other:

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3. Dealership information:
* Dealership Name: * Mailing Address: * City:
* State/Province: * Zip: Email:	* Phone: Phone Extension: Fax:
Shipping Address (if different from mailing): City:
State/Province:	Zip:

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4. Reason for interest in this service: (i.e. high warranty expense)

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* 5. Discounts: If you received a direct mail piece please provide the offer code to apply any applicable discounts.
OC# (Found near phone # or mailing label)
If you didn't receive a direct mail piece (postcard / letter / flyer), how did you know to seek J&L Warranty Pros for help?
	Other: