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X-Change On-Line Order Form

X-Change Program Handbook
 
Voith: Engineered Reliability

X-Change On-Line Order Form
Note Please refer to the X-Change Program Handbook for instructions on completing this form and preparing your transmission for shipment. Items marked with * are mandatory.
Customer Information:
*First Name:  
*Last Name:    
*Phone #    
*Fax #  
*Email address:

*Company Billing Address:
Company: 
Street: 
City: 
Country: 
State/Province: 
Zip/Post code:  

*Company Ship-to Address: same as billing
Company: 
Street: 
City: 
Country: 
State/Province: 
Zip/Post code: 

Transmission Information # 1
*Serial # 
*Model# 
*Pattern# 
*Type: 

Order Information
*Purchase order # 
Pricing as understood by customer
               USDCDN
Requested Delivery Date MM/DD/YY
Note: All transmissions must be returned with their oil cooler. All DIWA.2 transmissions must be returned with an ECU that has a serial number matching the transmission.

Optional 6 Month Extended Warranty requested? (DIWA.2 only) Yes    No

*Is this a “bus down” situation?  Yes   No

*Do you require the return of the same Serial # Transmission?  Yes   No

Has this transmission been rebuilt by VOITH before?  Yes   No  Unknown

ATF Oil Type & Manufacturer:

Approx Mileage on transmission:

Description of failure and/or special instructions:

Due to sharply and steadily rising fuel costs, passed on to us by our preferred carriers, effective Monday, March 10, 2008 Voith Turbo Inc. will be implementing a Fuel Surcharge on all outbound X-Change shipments. Depending on destination, these charges will amount to between $50-$200 dollars per shipment. You must click this checkbox to acknowledge you have read this section.

By clicking Submit Order I agree to these terms and conditions.