HoltCat
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Engine Form

HOLT CAT® Truck Engine Policy Authorization Form

Please fill out the form below and submit. All fields are required.

Who would you like to send the form to?
 
DEALER INFORMATION
Truck Dealer:
Date:
Contact Person :
   
CONTACT INFORMATION
Customer Name :
Customer Address:
   
ENGINE INFORMATION
Engine Serial Number:  
Current Mileage:  
Delivery Date:  
OEM:  
Model:  
VIN#:  
ESC:
Term:  
Type:
Part Causing Failure: /
(part #, part name)
Parts Warranty: /
(start date/ mileage)
Group#:
Desc. Code:
SIMMS Comment: (20 chars)
(be location specific: #1 misfire, #2, 3, 4 inj repld #6 valve dropped, water pump leak, etc)
   
 
 
 
CLAIM STORY
Complaint:
   
Cause:
   
Correction:
   
Customer Participation:
   
Reason for Policy Request:
   
 
 Did You Know
…our paint shop will paint any equipment any color you choose.