TRANSMISSION CORE RETURN• Check List • Before you start Please read and accept below Xcalliber only pays for the transmission core return freight within the 48 continental U.S. states. Additional ancillary charges such as a liftgate charge, leaking transmission, re-palletizing of transmission and any other charges excluding freight will be the responsibility of the customer and invoiced directly to the customer by Xcalliber. Accept and continue CUSTOMER TRANSMISSION MUST DO Please check all items. A PDF copy will be emailed to you after submission. Include this form with your returned transmission core. Remove the following items from the transmission core for re-installation purposes: Dipstick and Tube Output Yoke/Flange External Harness Park Brake Components Motor Mount Brackets Ring Gear NSBU Switch Cooler Fittings (if applicable) Bell Housing Dowel Pins (if applicable) Drain ALL fluids and secure oil pan plug. Install ALL shipping plugs and caps on the transmission core. Secure the torque converter to the transmission core. Secure the transmission core to the shipping case from your order. Check that the returned transmission core has the same serial number as the requested transmission. Prepare and return transmission core the same way your unit was received. Yes No Do You Need a Liftgate? Core Invoice # First Name Last Name Date Available for pick-up from: 12:00 am 1:00 am 2:00 am 3:00 am 4:00 am 5:00 am 6:00 am 7:00 am 8:00 am 9:00 am 10:00 am 11:00 am 12:00 pm 1:00 pm 2:00 pm 3:00 pm 4:00 pm 5:00 pm 6:00 pm 7:00 pm 8:00 pm 9:00 pm 10:00 pm 11:00 pm to 12:00 am 1:00 am 2:00 am 3:00 am 4:00 am 5:00 am 6:00 am 7:00 am 8:00 am 9:00 am 10:00 am 11:00 am 12:00 pm 1:00 pm 2:00 pm 3:00 pm 4:00 pm 5:00 pm 6:00 pm 7:00 pm 8:00 pm 9:00 pm 10:00 pm 11:00 pm CUSTOMER INFORMATION (need for Bill of Lading) Company Name Address (where transmission is to be picked up) City State/County/Province Canada (CA) Mexico (MX) United States (US) Country Zip/Postal Code Contact Name Email Fax # Phone # Special Notes (are there special hours, is there a loading dock, etc.) For Internal Use Only Once your transmission core is received by , it will be thoroughly inspected. Any damage listed below will be deducted from the core credit. If the returned transmission core is without damage, then the customer will receive full credit for their core. Transmission core inspection revealed: Damaged Transmission Case (deduction) LCT 1000/2000 Series: (-$200.00) MD/B400 Series: (-$300.00) HD/B500 Series: (-$400.00) Damaged Torque Converter (deduction) LCT 1000/2000 Series: (-$200.00) MD/B400 Series: (-$400.00) HD/B500 Series: (-$600.00) Damaged Bell Housing (deduction) LCT 1000/2000 Series: (-$200.00) MD/B400 Series: (-$300.00) HD/B500 Series: (-$400.00) Damaged Oil Sump (deduction) LCT 1000/2000 Series: (-$50.00) MD/B400 Series: (-$150.00) HD/B500 Series: (-$300.00) Damaged Tail Housing (deduction) LCT 1000/2000 Series: (-$150.00) MD/B400 Series: (-$200.00) HD/B500 Series: (-$250.00) Missing Shipping Plugs (deduction) LCT 1000/2000 Series: (-$25.00) MD/B400 Series: (-$50.00) HD/B500 Series: (-$50.00) Please note: ALL costs and/or fines accrued due to improper core preparation during the return to will be the sole responsibility and liability of the customer. By checking this, I verify to that all the information entered is accurate. Should something be incorrectly entered which would lead to an additional charges incurred by Xcalliber, these charges would be the sole responsibility and liability to the customer. For Example : Should a customer state “No lift gate is needed”, and in fact it is, any additional charges incurred by Xcalliber will be the sole responsibility of the customer, and passed on to the customer a the customers’ expense. Submit 115 Commerce Drive, Brookfield, CT 06488, USA Call: 1.800.682.1290 Fax: 203.775.0816 Email: billing@xcalliber.com Visit us at: www.xcallibertransmission.com