Taylor Made Ambulance

TAYLOR MADE AMBULANCE WARRANTY FORM

Name of Agency 

Contact Name 

Email Address 

Phone Number 

Fax Number 

Type of Vehicle  Type I-truck chassis Type II-van Type III-Cutaway Rescue Truck Command Vehicle Specialty Truck

Chassis Manufacturer  Ford GM International Freightliner Dodge Other

    If other, please specify 

Model Year 

Mileage 

Vehicle ID Number (VIN) 

Warranty problem or issue