SYSTEM DIAGNOSTICS REQUEST FORM – OEM

DEALER/SERVICE CENTER INFORMATION:

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:

VEHICLE OWNER Phone *

VEHICLE OWNER Name *

First

Last

VEHICLE OWNER 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

Description of the trouble:

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