SYSTEM DIAGNOSTICS REQUEST FORM – DEALER

DEALER/SERVICE CENTER INFORMATION:

HWH Customer # (if known)

Company Name *

dba Company Name

Contact Name *

First

Last

Contact Phone Number *

Phone Extension

Email *

Company Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

VEHICLE OWNER INFORMATION (Information required for diagnostics records only.):

VEHICLE OWNER Phone *

VEHICLE OWNER Name *

First

Last

VEHICLE OWNER Home Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Customer HWH Account # (if known)

VEHICLE INFORMATION:

VEHICLE Year *

VEHICLE Manufacturer *

VEHICLE Model *

Layout

VEHICLE VIN

Please use a VIN checker to ensure you are sending us a valid VIN: vpic.nhtsa.dot.gov/decoder

Vehicle Serial #

(VIN Helpful if added now but not required now. Tech will need VIN before processing call, so please have available.)

Vehicle Use *

Date of Purchase – VEHICLE

Date of Purchase – SYSTEM

Leveling System Information

Control System

Jack Style

Room Extension Information/Description

Nature of Problem:

Upload a picture of the part if available.

Click or drag files to this area to upload. You can upload up to 3 files.

(.png, .gif, .jpg)

Can you safely move your vehicle?

Yes
No

HWH calls might come thru on cell phones as "SPAM".
You can expect HWH calls to come from "563" area code.

Submitting this form will put you directly on our Tech call-back list.
Currently the call-back wait time is estimated at same day.