Instructions

REQUEST FOR REIMBURSEMENT - LACK OF POWER STEERING ASSIST:

1 R.O.# & DATE The dealership should enter the repair order number and date of the

owner's or dealer's paid receipt or invoice.

2 REQUEST DATE
(MONTH,DAY) Date owner or dealer requested reimbursement.

3 VEHICLE
IDENTIFICATION
NUMBER VIN involved.

4 MILEAGE Enter mileage at time of transaction. (If not available, enter "0".)

5 CC/FC Code is preprinted on form.

6 LABOR OPERATION Labor Operation is preprinted on form.

7 & 8 SUBLET DMN & Enter total amount of reimbursement. (Do not enter parts or labor hours

LINE TOTAL on claim.)

9 AUTH CODE If the amount of reimbursement approved is $500 or less, no authorization
is needed. If the amount exceeds $500, advise customer to contact Chevrolet Customer Assistance at 1-800-222-1020.

10 REQUESTED Dealer Service Manager enter amounts determined from owner supplied
REIMBURSEMENT invoices or paid receipts, which are covered.

11 APPROVED AMOUNT Dealer Service Manager to determine based on reimbursement policy of
this bulletin. If the total amount exceeds $500, contact Chevrolet Branch Customer Assistance Representative for instructions.

12 740 STAMP See Item # 11 to determine need for authorization.

13 DEALER REFERENCE
INFORMATION
A Enter Document Number and Line Number on which claim was submit-

ted

B Enter Claim Memo Number and Date when claim is credited.

C Enter number of dealer check to owner, if applicable. Date check was
written, if applicable. Date copy of check was attached to OWNER REQUEST FOR REIMBURSEMENT file.

14 OWNER INFORMATION Must include telephone number.

15 DEALER INFORMATION Includes Dealer Code, Dealer Name, Service Manager's signature and
social security number. To be completed by Service Manager.

16 EXPLAIN Should the dealer Service Manager determine, after review of owner's
invoices/receipts, that the reimbursement case is not eligible; Service Manager should write reason on worksheet, explain to owner, and place a copy of the worksheet in the file.

17 The dealer is then to issue the owner a check for the reimbursement in the approved amount. A copy of the
check issued to the owner is to be attached to the dealer's file copy of the request and retained for 24 months from date of credit.