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RV Systems
» RV Pre-Authorization Checklist
RV Pre-Authorization Checklist
If you'd prefer to download and/or print the form,
click here
.
* Required
Customer Information
Contact Name
*
Contact Phone Number
*
Complaint
*
Cause and Correction
*
Date of Failure
*
Date of Repair
*
Labor Time Requested
*
Part Number Needed
*
System and Vehicle Information
RV Case Number
Complete Vehicle VIN
*
Vehicle Year
Vehicle Make
Vehicle Model
Bergstrom Unit Part Number from Base Unit
Bergstrom Unit Serial Number from Base Unit
Vehicle In-Service Date
*
Vehicle Mileage
Labor Rate
Repair Facility Name
Repair Facility Address
Please type the number
52660
:
*
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