Suzuki SX4 2012 Warranty & Maintenance Information page 38

5. Details of your vehicle Disablement
Date:
Cause Mechanical Breakdown (please specify):
Other (please specify):
6. Make Cheque Payable To (if Different from owner):
Name
Address
Prov
Postal Code
7. "i have completed this form and certify that the information provided is complete and accurate."
Signature of owner
8. Sign and mail this completed form with original receipts to:
Suzuki Secure Advantage Roadside Assistance
P.O. Box 190, 135 West Beaver Creek, Richmond Hill, ON L4B 4R5
Location:
Business Phone
City
Extension
Date
- 36 -