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

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?

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