We have several options for payment:
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OR you can,

print this form out, fill it in completely and
fax, or snail-mail together with your payment to:

RR and B Motorcars, LLC

5YrWarranty Dept.

150 Jensen Hills Dr

Fenton, MO 63026

Phone: 314.754.6349 *** Fax: 314.779.2652

 

5 Years &/OR 100,000 Miles $0 Deductible
Warranty Registration Form

 

Name: _______________________________________________

Address: _____________________________________________

City. State, Zip: _______________________________________

Phone: _____________________________

Phone: _____________________________

e-Mail: ______________________________________________

 

Purchase Date: _______________________________________

Purchase Price: _______________________________________

Lien Holder: __________________________________________

 

Year: ______________________________

Make: _____________________________

Model: ____________________________

VIN: ______________________________

Current Miles: ______________________

  ====================================================

5 Yrs/100,000 Miles Warranty:       $895.

 

Surcharges if any:                             Check if applicable
4x4/AWD Vehicle:                            $100 ______  
Luxury Vehicle (See Below):            $100 ______       

Maximum Surcharge (if applicable):      $200            

 

Total Amount Due:                           $_________

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We also accept personal or business checks, US Postal Money Order, or Credit Cards (VISA & MASTER CARD).  For Credit Card Payment, do NOT send card information, we will call you to get live verification.

Please call me for my Credit Card Information: _________  

 Luxury Vehicles: Audi, BMW, Mercedes, Porsche, Saab, Volvo

 

Non Qualifying Vehicles: AutoLifeRx™ and its limited warranty are not intended for and does not apply to Acura NSX, Diesel engines manufactured prior to 1990, Rotary engines, 4100 GM engines, Dodge Stealth, Land Rover, Mitsubishi 3000GT, Nissan Z and ZX series, Porsche 911, 928, or 930, Renault Viper, 10 and 12 cylinder vehicles.

THIS LIMITED WARRANTY BEGINS ON THE START DATE LISTED ABOVE AND EXPIRES AT 12:01 A.M. AT THE END OF THE TERM SPCIFIED IN THIS REGISTRATION, OR WHEN THE VEHICLE HAS REACHED THE ADDITIONAL MILEAGE LIMITATION SPECIFIED IN THE LIMITED WARRANTY REGISTRATION AGREEMENT, WHICHEVER OCCURS FIRST. ALL MAINTENANCE REQUIREMENTS MUST BE COMPLETED.

 

IMPORTANT CUSTOMER NOTICE:
THE ADDITIVE WILL BE SENT TO YOUR ADDRESS LISTED ABOVE.
IT IS YOUR RESPONSIBILITY TO INSTALL THE ADDITIVE.
IF YOU NEED HELP, PLEASE CALL US WE WILL BE ONLY
TO HAPPY TO ASSIST YOU 

 

             
                   Terms and Conditions: Agreed to and Accepted By:

 

_______________________________                _______________________________
Signature, Vehicle Owner                                   Signature, Authorized Agent

_______________________________                 _______________________________

Printed Name, Vehicle Owner                              Printed Name, Authorized Agent

Date: ________________________                    Date: ________________________