Spicer Purchased Warranty Registration Form – Vocation Mining - Manual (Page 2)

Purchased Warranty Registration Form – Vocation Mining
This form should be used to register eligible vehicles. Completion of this form is only required for a purchased extended warranty.
Important: To ensure this Extended Warranty registration can be processed, please provide complete and accurate answers to the
information requested below. Failure to do so could cause delays in registering the vehicle.
Required Registration Information
Owner: ____________________________________ Dealer__________________________________
Address____________________________________ Address:________________________________
City__________________________ State_________ City:______________________ State_________
Postal Code_________________________________ Postal Code: _____________________________
Email:_____________________________________ Email:__________________________________
Vehicle & Component Information
Chassis Vin (17 Characters): __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
OEM:____________ Current Mileage:________________ Vehicle In-Service Date_____________
License Plate #: ________________ State: ______________
Drive Axle: Model______________ Drive Axle Serial No.______________
Steer Axle: Model______________
Transmission: Model______________ Trans Serial No.___________________
Clutch:
Model______________
Suspension: Mfg _________ Model ______________
Drive Shaft Series: Main _______________ Interaxle ______________
Engine: Make________________ Model _____________
Peak Torque ___________Lb.Ft.
________________________________________________________________________________________________
Remittance Instructions
Checks should be made Payable to Dana - CVSD. Checks may be written by the dealer or the owner. Check and registration forms
should be mailed to the following address:
Dana- CVSD
Attn: Warranty Registration
Check #_______________
P.O. Box 4097 Check Date: ____________
Kalamazoo, MI 49003-4097 Check Amt: ___________
_______________________________________________________________________________________________
Before signing below, please read this section carefully!
‰
I/we have read, understand and accept the terms of the Extended Warranty as set forth in bulletin abib-0501.
‰
I/we do not wish to purchase extended warranty at this time and acknowledge that this warranty must be purchased
within 12 of the date the vehicle is placed in service.
‰
I/we understand, if this extended coverage is not purchased, Dana’s warranty obligation will end at the expiration of the
base/standard warranty coverage period.
OWNER Signature:_____________________________________ Dealer Signature: ____________________________
Date: ____/____/____
Dealer (Printed): ____________________________
For spec’ing or service assistance, call 1-800-24 hours a day, 7 days a week
Or visit our web site at: http://www.VSLFHUSDUWV.com
Dana Corporation
ABIB-0501 Copyright Dana Corporation, 2005 Heavy Vehicle Technologies and Systems Service
January 2005 All Rights Reserved. P.O. Box
Printed in U.S.A. www.dana.com 7ROHGR2KLR