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Your Information

Please provide a clear image of the barcoding label from the box in which the product was shipped. This will help expedite your request. Warranty requests without the label information may be delayed.

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Purchase Information

Part Number(s) Purchased*

Date Purchased*

MM slash DD slash YYYY

Where did you make your purchase?*

How was the vehicle being used when the failure occurred?*

Who installed the product?*

Installation Invoice Upload (Optional)

Max. file size: 32 MB.

Vehicle Information

Year*

Make*

Model*

Drivetrain*

Is the vehicle on which the product is installed used for commercial purposes?

Yes

What is the defect in the product?*

What is your preferred contact method?*

Phone

Do you own the vehicle in which the product is installed?*

Yes

Has the product ever been in stalled on another vehicle?*

Yes

Upload image of the damaged item(s)*

Max. file size: 32 MB.

Upload your proof of purchase*

Max. file size: 32 MB.

Upload the label(s) from the product box

Max. file size: 32 MB.

Company Name*
Company Website
Current SSI Contact*
How did you hear about us?*
Accounts Payable Contact
Person responsible for Accounts Payable
Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Person responsible for Accounts Payable Statements*
- Same as Accounts Payable
- Someone else
Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Purchasing Agent*
- Same as Accounts Payable
- Same as Accounts Payable Statements
- Someone else
Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
To whom should we send purchasing/shipping notifications?*
Select all that apply
- Same as Accounts Payable
- Same as Accounts Payable Statements
- Purchasing Agent
To what address should we ship product?*
- Accounts payable contact
- Accounts payable statements contact
- Purchasing agent contact
- New address
Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Add a note for the team:
optional
By completing this form, you agree to allow SuperSprings International to publish your business information on our website as an official distributor.*
- I agree

Company Name*
Company Website
Current SSI Contact*
How did you hear about us?*
Tax Exemption form
Max. file size: 32 MB.
Please download the form from the link above and attach the completed version here. We must have this information in order to receive your new account information.
Accounts Payable Contact
Person responsible for Accounts Payable
Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Person responsible for Accounts Payable Statements*
- Same as Accounts Payable
- Someone else
Name
First Last
Company Title
Phone
Email
Address
Street Address Address Line 2 City State ZIP Code
Purchasing Agent*
- Same as Accounts Payable
- Same as Accounts Payable Statements
- Someone else
Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State ZIP Code
To whom should we send purchasing/shipping notifications?*
Check all that apply
- Accounts Payable contact
- Accounts Payable Statements contact
- Purchasing Agent contact
To what address should we ship product?*
- Accounts Payable address
- Account Payable Statements address
- Purchasing Agent address
- New address
Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Add a note for the team:
optional

JUSTIN COULTER
Director of Sales
502.552.1683‬
[email protected]

"*" indicates required fields

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