{"id":13564,"date":"2024-11-01T16:41:17","date_gmt":"2024-11-01T16:41:17","guid":{"rendered":"https:\/\/jxtruckcenter.com\/?page_id=13564"},"modified":"2026-01-21T17:19:54","modified_gmt":"2026-01-21T17:19:54","slug":"warranty-claim-form","status":"publish","type":"page","link":"https:\/\/jxtruckcenter.com\/parts\/warranty-claim-form\/","title":{"rendered":"JX Warranty Claim Form"},"content":{"rendered":"\n\n\t\t<h1>\n\t\t\tTitle\n\t\t<\/h1>\n\t<nav id=\"breadcrumbs\" aria-label=\"Breadcrumbs\"><a href=\"https:\/\/jxtruckcenter.com\/\">Home<\/a> | <a href=\"https:\/\/jxtruckcenter.com\/parts\/\">Parts<\/a> | <strong>JX Warranty Claim Form<\/strong><\/nav>\n\t\t\t<h3>JX Warranty Claim Form-2017-R2<\/h3>\n\t\t\n                            <h2>JX Warranty Claim Form<\/h2>\n                            \n\t\t\t\t\t\t\t&quot;*&quot; indicates required fields\n                        <form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_167' id='gform_167'  action='https:\/\/jxtruckcenter.com\/parts\/warranty-claim-form\/?fl_builder&#038;fl_builder_ui_iframe#gf_167' data-formid='167' novalidate>\n                        <label class='gfield_label gform-field-label' for='input_167_82'>Company<\/label><input name='input_82' id='input_167_82' type='text' value='' autocomplete='new-password'\/>This field is for validation purposes and should be left unchanged.<h3>Customer Information<\/h3><label class='gfield_label gform-field-label' for='input_167_25'>Sponsoring Branch*<\/label><input name='input_25' id='input_167_25' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_167_26'>Fleet Name*<\/label><input name='input_26' id='input_167_26' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_167_77'>Account Number*<\/label><input name='input_77' id='input_167_77' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_167_28'>Fleet Contact Name*<\/label><input name='input_28' id='input_167_28' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_167_4'>Phone*<\/label><input name='input_4' id='input_167_4' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_167_3'>Email*<\/label>\n                            <input name='input_3' id='input_167_3' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <h3>Vehicle Information<\/h3><label class='gfield_label gform-field-label' for='input_167_78'>Work Order\/ RO#*<\/label><input name='input_78' id='input_167_78' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_167_32'>Date of Failure*<\/label>\n                            <input name='input_32' id='input_167_32' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_167_32_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            MM slash DD slash YYYY\n                        <input type='hidden' id='gforms_calendar_icon_input_167_32' class='gform_hidden' value='https:\/\/jxtruckcenter.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><label class='gfield_label gform-field-label' for='input_167_33'>Make*<\/label><input name='input_33' id='input_167_33' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_167_79'>Mileage @ Time of Failure*<\/label><input name='input_79' id='input_167_79' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_167_35'>Vehicle Serial Number*<\/label><input name='input_35' id='input_167_35' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_167_6'>Complaint<\/label><textarea name='input_6' id='input_167_6' class='textarea small'    placeholder='What doesn&#039;t work?'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><label class='gfield_label gform-field-label' for='input_167_36'>Cause<\/label><textarea name='input_36' id='input_167_36' class='textarea small'    placeholder='What was failed that caused the complaint?'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><label class='gfield_label gform-field-label' for='input_167_37'>Investigation<\/label><textarea name='input_37' id='input_167_37' class='textarea small'    placeholder='How was the cause found?'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><label class='gfield_label gform-field-label' for='input_167_38'>Correction<\/label><textarea name='input_38' id='input_167_38' class='textarea small'    placeholder='What was done to repair the cause after the investigation was done?'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><h3>Claim Information<\/h3><label class='gfield_label gform-field-label' for='input_167_76'>Total Repair Hours Claimed<\/label><input name='input_76' id='input_167_76' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><label class='gfield_label gform-field-label' for='input_167_64'>Labor Rate per\/hr<\/label><input name='input_64' id='input_167_64' type='text' step='any'   value='' class='large'    placeholder='USD'  aria-invalid=\"false\"  \/><fieldset id=\"field_167_66\"><legend class='gfield_label gform-field-label gfield_label_before_complex'>Parts<\/legend>NumberDescriptionQtyPrice Ea.Total&nbsp;<input aria-invalid='false'   aria-label='Number, Row 1' data-aria-label-template='Number, Row {0}' type='text' name='input_66[]' value=''   \/><input aria-invalid='false'   aria-label='Description, Row 1' data-aria-label-template='Description, Row {0}' type='text' name='input_66[]' value=''   \/><input aria-invalid='false'   aria-label='Qty, Row 1' data-aria-label-template='Qty, Row {0}' type='text' name='input_66[]' value=''   \/><input aria-invalid='false'   aria-label='Price Ea., Row 1' data-aria-label-template='Price Ea., Row {0}' type='text' name='input_66[]' value=''   \/><input aria-invalid='false'   aria-label='Total, Row 1' data-aria-label-template='Total, Row {0}' type='text' name='input_66[]' value=''   \/>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)'>Remove<\/button><\/fieldset><h3>Sublet Invoice Info<\/h3><fieldset id=\"field_167_65\"><legend class='gfield_label gform-field-label gfield_label_before_complex'>Parts<\/legend>$ Amt (USD)Description&nbsp;<input aria-invalid='false'   aria-label='$ Amt (USD), Row 1' data-aria-label-template='$ Amt (USD), Row {0}' type='text' name='input_65[]' value=''   \/><input aria-invalid='false'   aria-label='Description, Row 1' data-aria-label-template='Description, Row {0}' type='text' name='input_65[]' value=''   \/>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)'>Remove<\/button><\/fieldset><label class='gfield_label gform-field-label' 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