General Motors Product Field Action Reimbursement Form
This document is a reimbursement request form for repairs covered under General Motors Product Field Action. It guides customers on how to fill out and submit the form for reimbursement. Includes sections for both customer and dealer to complete.
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How do I fill this out?
To fill out this form, enter the requested details including your personal information, vehicle information, and repair details. Attach the necessary documentation as specified. Then, submit the form to your General Motors dealer for processing.
How to fill out the General Motors Product Field Action Reimbursement Form?
1
Enter your personal and contact details.
2
Provide the vehicle identification number and repair details.
3
Attach required documentation such as receipts and proof of payment.
4
Sign the form to authenticate the information.
5
Submit the form and documents to your General Motors dealer.
Who needs the General Motors Product Field Action Reimbursement Form?
1
Vehicle owners who have paid for repairs covered under a General Motors Product Field Action.
2
Customers seeking reimbursement for specific repair expenses.
3
Authorized representatives assisting vehicle owners with reimbursement requests.
4
General Motors dealers processing customer reimbursement requests.
5
Individuals keeping records of repair and reimbursement requests.
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1
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2
Click on the field you need to edit and make changes.
3
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4
Review all the information to ensure accuracy.
5
Save the edited form and prepare for submission.
What are the instructions for submitting this form?
Submit the completed form along with all required documentation to your General Motors dealer. Ensure all information is accurate and the necessary signatures are provided. For any questions, contact the GM Customer Assistance Center at 1-800-204-0261. My advice: Keep copies of all submitted forms and documents for your records and follow up if you don't receive a response within 30 days.
What are the important dates for this form in 2024 and 2025?
Check with General Motors for any updates on reimbursement deadlines for 2024 and 2025. Ensure timely submission for prompt processing.
What is the purpose of this form?
The purpose of this form is to request reimbursement for expenses incurred due to repairs covered under General Motors Product Field Action. Customers should fill out their personal, vehicle, and repair details along with attaching necessary documentation to authenticate their claims. This form ensures accurate processing and proper handling of reimbursement requests by both customers and General Motors dealers.
Tell me about this form and its components and fields line-by-line.
- 1. Customer Name: Enter the full name of the customer requesting reimbursement.
- 2. Street Address or P. O. Box Number: Provide the mailing address of the customer.
- 3. City: Enter the city of the customer's address.
- 4. State: Provide the state of the customer's address.
- 5. Zip Code: Enter the postal code for the customer's address.
- 6. Daytime Telephone Number: Provide a daytime contact number including the area code.
- 7. Evening Telephone Number: Provide an evening contact number including the area code.
- 8. Date Request Form Submitted to Dealer: Enter the date the form and documentation are submitted to the dealer.
- 9. Vehicle Identification Number: Provide the 17-character VIN of the involved vehicle.
- 10. Mileage at Time of Repair: Enter the mileage of the vehicle when the repair was done.
- 11. Date of Repair: Enter the date on which the repair was completed.
- 12. Amount of Reimbursement Requested: Specify the amount requested for reimbursement.
- 13. Customer's Signature: Customer needs to sign here to attest the genuineness of provided information.
- 14. Bulletin No.: To be completed by the dealer, indicating the bulletin number.
- 15. Request Approved or Denied: Dealer will check whether the request is approved or denied.
- 16. Date: Dealer provides the date of approval or denial.
- 17. Amount: Dealer specifies the approved reimbursement amount if applicable.
- 18. Reviewed By: Dealer indicates who reviewed the request.
- 19. Reason for Denial: If denied, a reason is provided and a copy is retained for records.
What happens if I fail to submit this form?
Failing to submit this form may result in not receiving the reimbursement for repair expenses. It is crucial to complete and submit the form promptly.
- Loss of Reimbursement: You may not get reimbursed for the covered repair expenses.
- Delayed Processing: Incomplete or late submission may result in delays in processing your request.
How do I know when to use this form?
- 1. Covered Repair Expenses: To claim reimbursement for repairs listed in the General Motors Product Field Action.
- 2. Documenting Repair Costs: For keeping records of repair costs covered under the field action.
Frequently Asked Questions
How do I fill out the General Motors Reimbursement Form?
Enter your personal, vehicle, and repair details. Attach required documents, sign, and submit to your GM dealer.
Can I edit the form online?
Yes, you can use PrintFriendly's PDF editor to modify the form before submission.
Is it possible to sign the form digitally?
Yes, PrintFriendly allows you to add a digital signature to the form.
How do I submit the form once completed?
Submit the form to your General Motors dealer along with required documents.
What documents should accompany the form?
Attach receipts, invoices, proof of payment, and other required documentation.
Can I share the form digitally?
Yes, you can use PrintFriendly to share the form via email or a shareable link.
Who needs to fill out this form?
Vehicle owners or authorized representatives requesting reimbursement for repairs.
What if my request is denied?
You will receive a written explanation for the denial from your GM dealer.
How long do I wait for a response after submission?
If you haven't received a response in 30 days, contact the GM Customer Assistance Center.
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