Name
Street Address
City
State
ZIP
E-mail Address: *
Phone #
Contact Name
Return Shipment Method
Type of Service Requested
Year
Production Month
Production Day
Production Year
Mileage
Make
Model
Trim Level
Engine
Emission Specification
Transmission
VIN#
ECM ID#
Trouble Codes
Description of Problem
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The entire form must be completed prior to submission.  If any item on this form is left blank, the form cannot be submitted.  If any field is not appropriate, then enter n/a in that field.

ECM REPROGRAMMING NOTE:  all units sent in for reprogrmming will be tested prior to the reprogramming.  You should only expect to be notified of these test results if error are detected.  Otherwise, the unit will be reprogrammed without notification of test results. 

PROM REPROGRAM NOTE:  vehicle information must be filled out completely to reprogram PROM info.  We cannot provide this service without this information.  The unit will be returned to you unprogrammed if the information cannot be provided.

TESTING NOTE:   Only basic functional testing will be performed on units without a detailed description of the driveability problem.  Please provide all information possible for maximum accuracy of the dynamic testing of your unit.