Automatic Transmission warranty Claim Form

Please fill out the form and fax to 770-888-1499. Thank you for your cooperation.

Order Number

Claim Number

Customer Name

Transmission Type #

Vehicle ID #

Model #

Decision to replace transmission was made by :

 Date of claim

        warranty Claim#

Can the complaint be verified ?

City, State & Zip

Your Phone#

         Yes                  No

Please provide a detailed description of  your complaint:               yes/No answers

Fail safe mode--


incorrect Oil level

          Oil leak 

locked in Gear

Shift problems


Oil leaks

Shift problems



In gear




Drive only


Broken Case

Torque Converter

Front seal

rear seal

Oil Pan

Shift Selector

electric connector

P-D up shift

D-4 up shift

3-4 up shift

4-5 up shift

5-4 downshift

4-3 downshift

3-2 downshift

2-1 downshift

N-R shift

condition occurs:          when hot        Always           when cold               intermitten
Vehicle mileage                             Date of Failure 
Your comments to the Complaint:

Signature                                 Date    
Note: Form must be filled out. No warranty will be accepted without this warranty Claim Form