Electronic Module Repair Form

Customer Details

Full Name: ____________________________________________

Phone: ________________________________________________

Email: _________________________________________________

Street Address: ________________________________________

Postcode: _____________________________________________

City / Town: ___________________________________________

Vehicle Details

Make: Volvo

Model: ________________________________________________

Fuel Type: Petrol / Diesel / Hybrid

UK Reg. Plate: ________________________________________

VIN, if no UK reg.: ____________________________________

Module and Fault Description

Module Name / Type: ____________________________________

Part / OEM No.: ________________________________________

Symptoms, what does vehicle do?

_______________________________________________________

What is not working, what function has been lost?

_______________________________________________________

Occurrence: Constant / Intermittent

Fault / DTC Codes stored:

_______________________________________________________

Please print stored fault codes from diagnostic scanner and include them with this form if possible.

Send module to

Volvo Diagnostic
19 Clipper Park Industrial Units
Tilbury, RM18 7HG
United Kingdom

Contact@volvodiagnostic.com
+44 1708 208836
www.volvodiagnostic.com