CLAIM FORM Date MM slash DD slash YYYY Name(Required) Technician's Full Name Phone Number (Optional)E-mail(Required) Customer's name(Required) For reference Montecarlo model(Required)LX1900LX2100FB21LXT (Transit)FB22 (Transit)Year20252024202320222021202020192018201720162015Last 8 characters of the serial number (e.g., JE851452)Type of Claim(Required)Part(s) Already ReplacedPart(s) to Order for ReplacementRepair Already PerformedRequest for Future Repair (please specify in comments)Comments(Required)Additional DetailsUpload Photo (Optional)(Text may appear in your browser's default language.)Max. file size: 256 MB.CommentsThis field is for validation purposes and should be left unchanged.
