WARRANTY CLAIM FORM
IMPORTANT: Only type information into this form, handwritten forms will be returned.
Instructions: Submit copy of completed form to ConMet Warranty Administrator and include
copy of completed form with returned parts shipment. See complete instructions on page 2.

* Required Fields

Claim Date*:

(Provided by ConMet)

ConMet Returned Goods Authorization (RGA) #*:

Claim #*:
Claim/Owner Information

Vehicle Information

Customer/Fleet Name*:

Vehicle #:

Contact Name*:

VIN # (17 Digit)*:

Address*:

In-Service Date*:
Vocation:

City*:

MI

Odometer*:

State/Province*:

Make:

Zip/Postal Code*:
Phone #*:

Model:
Fax #:

KM

Build Date*:
Failure Information

Repair Date*:
Failure Date*:
Aftermarket Replacement claims only - Replacement Date:

Repair Order #*:
Proof of purchase required

Repair Location Name*:
Contact Name*:

Phone*:

Location Address*:
Claim Narrative (Complaint, Cause, Correction)*:

Qty.

Parts
Part Description

Part #

If applicable

Note the position of the failed part in the claim narrative, i.e., "left, fwd rear axle, inner bearing"

Labor
Labor Operation

Part No. 10005759 Rev D
8/2017

ConMet Failed P/N*:
ConMet Hub Assy P/N:

USD Exchange Rate (if applicable):

Unit Price

Total Price
$ $ 0.00 $ $ 0.00 $ $ 0.00 $ $ 0.00 $ $ 0.00 $ $ 0.00 $ $ 0.00 $ $ 0.00 Total Parts: $ $ 0.00 -

Labor Time
(Hours/Tenths)

Labor Rate

Total Labor
$ $ 0.00 $ $ 0.00 $ $ 0.00 $ $ 0.00 $ $ 0.00 $ $ 0.00 Total Labor: $ $ 0.00 Total Requested:
$ 0.00

Warranty Claim
Filing Instructions
IMPORTANT: Only type information into the claim form, handwritten forms will be returned.

Note: Retain all failed parts until ConMet provides a part disposition. A ConMet Return

Goods Authorization (RGA) number MUST be issued before returning any parts and submitting a claim.
This RGA number is used to track claims and speed up the processing time.

To submit a ConMet Warranty claim, please follow the steps below:
1. Verify Coverage
Warranty documents can be found online at: www.conmet.com > Literature > Warranties
Note: Proof of purchase is required on all aftermarket parts claims.
2. Fill out the Form
Complete the ConMet Warranty Claim Form. Fields with an asterisk (*) are required fields. Claim forms
missing required information will be returned for corrections.
3. Email the Form
Email the completed form to [email protected] to obtain a ConMet Return Goods
Authorization (RGA) number.
Best Practice: Include a copy of the repair order when emailing the claim form for faster processing.
The submitted form will be reviewed and assigned to a warranty analyst. The analyst will respond
back to you via email with the parts disposition, an RGA number, and shipping instructions.
4. Parts Return
Claimant is responsible for all costs to return parts for inspection. Return freight costs will be
reimbursed if the failure is deemed warrantable.
When returning parts for inspection:
1) Include a copy of the claim form (that has the RGA number on it) with the returned parts
shipment.
2) Mark the outside of the shipping box with the RGA number and RGA line item number.
3) Keep 1 copy for your records.

Warranty Tips
Follow these tips to ensure the fastest claim processing:
• Submit claims as soon as possible after the repair.
• Accurately explain where the failure occurred on the vehicle, as well as on the part itself. Example:
“left, forward rear axle inner bearing”.
• Clearly describe the driver’s complaint, root cause of the failure, and the corrective action taken to
repair the failure in the claim narrative.
• Describe the failure with as much detail as possible. Instead of just saying “broken”, describe “latch
spring disengaged” or “latch cracked at pivot point.”
• If tests were performed or measurements taken, be sure to include the results in the Claim Narrative.

Part No. 10005759 Rev D
8/2017