Autotriz Warranty Registration

Owner's Name:

First Name

Last Name

Phone:

(###)

###

####

Email:

Vehicle Make:

Vehicle Model:

Vehicle Year Model:

Vehicle Rego:

Vehicle Color:

Person Completing This Form:

Date Vehicle Picked Up:

YYYY

Coating Applied:

Who Completed the Work:

(Please note: warranty does not apply if not installed by a certified Autotriz installer)

Installers Invoice/Receipt Number:

(Please note: Receipt will be required for any/all warranty claims)

Note's (if required):