Warranty Claim Form Type of Claim * Tire Claim Wheel Claim Claim Date Date you are filing the claim MM DD YYYY Owner of Trailer * registered Owner of the trailer First Name Last Name Shipping Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Trailer Manufacturer and Model: Who manufactured your trailer and what model is it. VIN # * VIN number of the trailer Date of Purchase MM DD YYYY Date of Trailer Mfg: MM DD YYYY Wheel Size Please Check One 10" 12" 13" 14" 15" 16" 17.5" Number of Lugs: Please Check One 4 5 6 8 Wheel Color Please Check One Black White Silver White with Stripe Special Dealer Name: Contact Person: Dealer Phone (###) ### #### Dealer Email Customer Name: Customer Phone (###) ### #### Customer Email Message * Thank you! We will get back to you shortly! *Must have all required documentation to process. *
