Go-Ped Warranty Claim Form
Serial Number
Name
Shipping Damage?
Yes
No
Address
Repair Date
Address (Cont.)
Dealer Number
City
Model
Select One
Sport
S25
Bigfoot
ESR750
ESR750 Sport
ESR750EX
GTR40
Know-Ped
Grow-Ped
GSR40
GSR Sport
GSR25
GSR29R
Super Bigfoot
Go-Quad 25
Super Go-Quad 30
Go-Wagon
Other
State
Warranty Reg. on file?
Yes
No
Zip
Email Address
Description of claim
Warranty Authorization Number
Parts Information
Dealer pricing only on parts - Please fill out all fields
Qty.
Part #
Description
Wholesale Cost Per
Total Wholesale Cost
Total Parts Cost
Labor Information
Hours
Rate
Description
Total
@$40.00 Per Hour
@$40.00 Per Hour
@$40.00 Per Hour
@$40.00 Per Hour
Total Labor Cost
Total Parts Cost
$
Total Labor Cost
$
Total Parts Credit Due
$