Online Technical Assistance Request Form Please complete and submit the following form to inform us of your service or parts requirements. Fields with asterisks (*) are required. VEHICLE INFORMATION Model Year* Model* Vehicle Identification Number* 17 characters Nature of Repair* 300 characters max. VEHICLE OWNER INFORMATION Owner First Name* Owner Last Name* Owner Street Address* City* State/Province* Two-letter code. For example, New York=NYZip / Postal Code* Country* Two-letter code. For example, United States=US Email Address* Phone Number Phone Location HomeWorkMobile DEALERSHIP / REPAIR SHOP INFORMATION Dealership/Repair Shop Name* Dealership Street Address* City* State/Province* (Two-letter code For example, New York=NY) Zip/Postal Code* Country* (Two-letter code. For example, United States=US) CONTACT INFORMATION (Owner or Dealer/Repairer) Contact's First Name* Contact's Last Name* Contact's Email Address* Contact's Phone Number* Contact's Phone Location* HomeWorkMobile
