Important note

Together with the completed form, all original receipts (note of delivery/invoice) documenting the purchase of the claimed part by the final customer and by the Workshop from the wholesaler have to be submitted.

Only completely filled in forms can be processed with out delay.

Please print this document and send it to:

Egon von RUVILLE GmbH
Postfach 74 02 27
D-22092 Hamburg

Warranty request no.

__________________________________
Date:

Manufacturer/Supplier
Name:
Contact person:
Address:
ZIP:
 		 City:
EMail:

Custom er/Workshop
Name:
Contact person:
Address:
ZIP:
 		 City:
 EMail:

Distributor
Name:
Contact person:
Address:
ZIP:
 		 City:
EMail:
Customer account no. workshop
 Receipt/Bill of delivery no. workshop
Customer account no. distributor
 Receipt/Bill of delivery no. distributor
re/ submitted by branch:
   		 Own warranty request no:
   		 Processed by:
Part no. of the manufacturer:
    		 Description:
    		 Part no. of the retailer:
Other:
Vehicle make an model:
    		 VIN-no.:
    		 Chassis no.:
Engine type: 
    		 Engine no.: 
    		 Displacement: 
   		 hp/KW:
    
First registration: 
    		 Installation date: 
    		 at mileage: 
    		 Dismounting date: 
    		 at mileage:
     

Complaint reason

give detailed description
Defect occurs:
Original receipts stating installation/dismounting costs of  Euro plus VAT are included in the shipment. Belated receipts concerning extra costs can not be considered.
Advance substitute was granted.
In case of acceptance of the warranty claim I prefer:
In case of non acceptance of the warranty claim I prefer:


I confirm that the given information is complete and correct.

 

_________ ________________________________

Date          Signature