User Guide

Claim Form Sample
*IF OTHER, PLEASE DESCRIBE:
Having discussed this adjustment claim in detail with the Owner-User, I am convinced that the merchandise presented for adjustment was not involved in a motor vehicle accident.
DEALER’S
SIGNATURE
I hereby certify that I am the original Owner-User of the above described merchandise was not involved in a motor vehicle accident and that all the foregoing statements are factually correct.
OWNER-USER’S
SIGNATURE
DISTRIBUTOR DEALER FLEET (Commercial Use Only) OWNER-USER
NAME: NAME: NAME: NAME:
ADDRESS: ADDRESS: ADDRESS: ADDRESS:
PHONE NUMBER: PHONE NUMBER: PHONE NUMBER: PHONE NUMBER:
ACCT#: ACCT#: ACCT#: ACCT#:
VEHICLE INFORMATION
YEAR MAKE MODEL
INSTALL
DATE
INSTALL MILES REMOVAL MILES TOTAL MILES
VEHICLE USAGE
(NORMAL/ COMMERCIAL/ OFFROAD/ RACING/ ETC.) ORIGINAL EQUIPMENT VIN NUMBER
ITEM
NO.
SIZE/ TYPE/ PLY
FOR OFFICE
USE ONLY
MATERIAL NO.
MFG’S SERIAL NO.
(Commercial Use Only)
D.O.T. NUMBER
PSI
32NDS
REMAINING
RFV or Balance
WT (OZ/GR)
Tire Position
(LF,LR,RF, RR)
CLAIM REASON
# OF
RETREADS
1
2
3
4
5
6
DATE OF CLAIM
TIRE CLAIM FORM
HANKOOK TIRE AMERICA CORP.
Technical Department
333 Commerce Street, Suite 600
Nashville, TN 37201
Tel: 1-800-HANKOOK (426-5665), opt 1
THIS FORM MUST BE ACCURATELY COMPLETED BY THE DEALER AND SIGNED BY
OWNER USING THE PRODUCT. INCOMPLETE FORMS WILL NOT BE ACCEPTED.
Pattern Name:
TIRES MUST BE HELD UNTIL FURTHER NOTICE, OR UNTIL CREDIT IS RECEIVED. SHOULD TIRES BE
REQUESTED FOR INSPECTION AND BE UNAVAILABLE, ADJUSTMENTS CREDIT WILL NOT BE ISSUED.
INSTRUCTIONS:
30+ PC/LT, OR 6+ COMMERCIAL TRUCK TIRES CALL TECHNICAL DEPARTMENT.
4401_0120_01
PLEASE INSERT:
– CUT OUT ONE COMPLETE D.O.T. NO. PER TIRE (NOT APPLICABLE TO
COMMERCIAL TRUCK TIRE CLAIMS)
– PHOTOS CLEARLY SHOWING CLAIMED CONDITION (MIN 1 PER TIRE)
– ALL SUPPORTING DOCS (PURCHASE, MAINTENANCE, REMOVAL, ETC)
RETAIN COPY FOR YOUR RECORDS.
RETURN DOCUMENTATION TO: HANKOOK TIRE AMERICA CORP.
YES NO
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29
28
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Freight Policy
This Marketing Policy applies to all Hankook brand tires distributed by Hankook Tire America Corp.
In this Marketing Policy, discounts and credits vary on the categories of products.
Following categories are used:
1.
PCR : Passenger Car Radial Tires (Including Z36: P235/75R15 XL, Dynapro AT & Dynapro AS: P-Metric, Radial RA08)
2. LTR : Light Truck Radial Tires
3. TBR : Medium Truck Radial Tires (Tires over 17.5”)
NOTE : Please fill in completely the following items:
1. Pattern Name
2. Month, Day, & Year of Claim
3. Distributor’s Contact Information
4. Dealer’s Contact Information
5. Fleet (commercial use only)
Contact Information
6. Owner’s Contact Information
7. Vehicle Year
8. Vehicle Make
9. Vehicle Model
10. Tire Installation Date
11. Install Miles
12. Removal Miles
13. Total Miles
14. Vehicle Usage
15. Original Equipment (Yes/No)
16. Vin Number
17. Size, Type, Ply-Rating of Tire
18. Material Number
19. MFG’s Serial Number
(commercial use only)
20. D.O.T. Number of Tire
21. Air Pressure Used
22. Remaining Tread Depth (Inch)
23. Road Force Measurement or
Total Balance Weight
24. Tire Position
25. Claim Reason
26. Number of Retreads
27. Additional Notes Regarding Claim
28. Signature of Dealer
29. Signature of Owner (User)
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