Daimler Vans Upfitter Portal - Delayed Warranty Form

Delayed Warranty Form

Be sure to activate your customer’s warranty by filling out and submitting the form below.

For more information, click here to download the Delayed Warranty policy.

Upfitter Token: *

Please log in to your MasterUpfitter Dashboard to view your Token.

VIN Number: *

Date in Service: * (mm/dd/yyyy)

Mileage: *

First Name or Company Name: *

Last Name:

Customer Address: *

Address Line 2:

Zip Code: *

City: *

State:

Customer Phone (Day): *

Customer Email:

By Submitting this Form on Date of 6/25/2017: *

I understand that all information regarding this vehicle (e.g., Recall and Field Service Campaigns, etc.) will be mailed to the above (Customer) name and address.
I acknowledge receipt of the applicable Owner's Service and Warranty Information book and accept the terms and conditions set forth therein including the Limited Warranty, Warranty disclaimer, and Limitation of Liability.
I certify that I have received the applicable Maintenance Manual and the Operator's Manual.
I acknowledge that I have been instructed on how to correct fifth wheel operation (if applicable).
I acknowledge that the Federal Safety Standards and Emission stickers are affixed to the driver's door frame.

All fields with * are mandatory.