Authorization Form

Return Authorization Form

*It is very important for us to have as much information as possible in order to determine the cause of the claim. The information given is critical in determining if there is an issue with the fit or function of our products.

Authorization Form

Customer Name *

Today's Date: *

Phone #: *

Remember to enter the prefix of your country, for example: +1 1234567890 (Try not to use spaces)

Email Address: *

Address

City

State/Province

Zip/Postal

Country

Reason for Return:

Packaging

Fitment Issues

Quality

Part # Submitting Claim For (Starts NA-, NX-, FX-, NW-): *

Make (e.g. Honda, Polaris): *

Model (e.g. CRF250R, RANGER 800): *

Year of unit: *

Retailer Purchased From:

Date of Purchase:

Installation performed by

Hours/Run Time on Unit when Issue was Identified:

Complete Summary of Defect

Aftermarket/Performance Parts Installed on Unit:

Valve Train, Connecting Rod/Crankshaft Used (OEM/Aftermarket):

Fuel Type : Octane & Ethanol, or/and fuel mix ratio:

Installation Piston Clearance (piston to cylinder wall clearance): *

Remember to use ( . ) and ( " ) Example 0.124"

Installation Ring End Gap: *

Remember to use ( . ) and ( " ) Example 0.124"

List of the Cylinder work done prior to Install (Honed, bored, Coated):

Break-In procedure:

Addition information you feel will be helpful:

Upload images:

Maximum file size: 2.1MB

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In order to make accurate claim analysis please submit pictures of the piston, cylinder, cylinder head, connecting rod/bearings, and valves.

After review we may request the items be returned. Only send upon authorization from Namura Technologies. When returning please ship item pre-paid including proof of purchase.

Return Address:

Namura Technologies Inc.
ATTN: Warranty
15215 Boulder Trail
Rosemount, MN 55068

DISCLAIMER: If this form is not filled out properly or lacks details, Namura Technologies Inc. reserves the right to refuse any return or warranty actions.