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Appendix A
Warranty Claim Form
Irbit Motorworks of America, Inc.
Dealer_________________ ______Authorized #___________Date/__/__/__/
Motorcycle Information
VIN # /__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/
Engine /__/__/__/__/__/__/
Gearbox /__/__/__/__/__/__/ Model ____________ Mileage (km)_________
Owner’s Name______________________ Date of Registration /___/___/___/
Complete
Address___________________________________________________________________________
Comments_________________________________________________________________________________
Service Information
Technician__________________Start Date /___/___/___/ Completion Date /___/___/___/
Diagnosis of Defect________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________
Part # Description Qty Dlr. Cost
____________________ ______________________ ______ _________
____________________ ______________________ ______ _________
____________________ ______________________ ______ _________
____________________ ______________________ ______ _________
____________________ ______________________ ______ _________
____________________ ______________________ ______ _________
____________________ ______________________ ______ _________
Parts Total $__________
All warranty parts are shipped using standard UPS ground only.
Flat Rate Schedule: Check the items that pertain to this claim.
1. Engine
2. Gearbox
3. Final Drive
4. Front Fork
5. Wheel & Tire
1.1 __ 1.4hr
1.7 __ 0.1hr
2.1 ___ 0.5hr
3.1 ___ 0.3hr
3.7 ___ 0.3hr
4.1 ___0.7hr
5.1 ___ 0.2hr
1.2 __ 1.5hr
1.8 __ 0.1hr
2.2 ___ 0.1hr
3.2 ___ 0.4hr
3.8 ___ 0.2hr
4.2 ___ 0.5hr
5.2 ___ 0.2hr
1.3 __ 2.0hr
1.9 __ 0.7hr
2.3 ___ 0.9hr
3.3 ___ 0.6hr
4.3 ___ 0.5hr
5.3 ___ 0.4hr
1.4 __ 1.5hr
1.10 __ 0.4hr
2.4 ___ 1.2hr
3.4 ___ 0.7hr
4.4 ___ 0.4hr
5.4 ___ 0.3hr
1.5 __ 0.2hr
1.11 __ 0.3hr
2.5 ___ 0.4hr
3.5 ___ 0.7hr
5.5 ___ 0.3hr
1.6 __ 0.1hr
1.12 __ 0.4hr
3.6 ___ 0.9hr
5.6 ___ 0.2hr
1.13 __ 0.3hr
6. Sidecar
7.Chassis
8. Electrical
6.1 ___0.3hr
6.5 ___ 0.2hr
7.1 ___ 0.3hr
7.5 ___ 0.2hr
8.1 ___ 0.6hr
8.5 ___ 0.2hr
8.9 ___ 0.3hr
6.2 ___ 0.1hr
6.6 ___ 0.2hr
7.2 ___ 0.5hr
7.6 ___ 0.2hr
8.2 ___ 0.4hr
8.6 ___ 0.3hr
8.10 ___ 0.1hr
6.3 ___ 0.3hr
6.7 ___ 0.4hr
7.3 ___ 0.4hr
7.7 ___ 0.4hr
8.3 ___ 1.2hr
8.7 ___ 0.2hr
8.11 ___ 0.2hr
6.4 ___0.4hr
7.4 ___ 0.3hr
7.8 ___ 0.2hr
8.4 ___ 0.6hr
8.8 ___ 0.1hr
Labor Information
Flat Rate Hours_______________ Shop Rate $_______________Total $_____________
Dealer Signature_________________________ Date_________
Summary of Contents for Gear Up 2003
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