Order-Form

AutomotiveModules.com Updated: MARCH 2023 (734) 228-8679

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MidwestTecKmart.com

Thunderbird 2002-05 Front Electronic Module Rebuild expert & Ford Trucks Gem. 1995 -2016

Work Order, (repair Authorization)

To print this form : just highlight the white portion of this page then click print ,then hand write the answers with a pen and place it in the package with your Module that you send in for repair. Please do not forget to sign this form.

Name....................................................Service Center Name(if you are a company).....................................................

Address.................................................................................City..............................State.......................Zip..................

Phone # (..........) ............ ................. Email or Cell Phone. ........... ................... ............................. .................................................

I am sending Module called.........................................................which Determined by qualified Tech:needs repair.

The part Number is............................................................... The Mileage is .............................................

Year...........Make..............Model........................ Vin ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... .... .... .... .....

Please write what is original customer Complaint ? in Simple Truth ,Non Technical Terms.

Did you replace any Part but it did not fix the problem ? or any prior attempt to repair this module?..........................

Diagnostic Codes if available #....................Code Full description............................................................................................

#......................Code Full description...........................................................................................

please be advised ,providing DTC Codes and their full definition is very helpful for our repair provide them here if

you have them.

Any Malfunction Indicator Lights is on? ........................ .......................... .......................

Name of the person who paid on line ............................................Payer Signature............................ Date..........................

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