Warranty Claim Form
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1WARRANTY CLAIM FORM
WARRANTY CLAIM NO.
ENGINE MODEL
ENGINE S/N
REPLACEMENT ENGINE S/N
CAUSAL PART NO.
DATE REPLACEMENT
# HOURS ON
REPLACEMENT PART CLAIM
YES
NO
PART INSTALLED
REPLACEMENT PART
DISTRIBUTOR
OEM
SUB DEALER
SERVICE DEALER
CUSTOMER NUMBER
DEALER/SUB NO.
COMPANY NAME
STREET ADDRESS
CITY, STATE, ZIP CODE
OWNER
CITY, STATE, ZIP CODE
STREET ADDRESS
ENGINE (name plate) RATING
TYPE OF MACHINE, MANUFACTURER & MODEL
CLAIMANT NO.
START-UP DATE
FAILURE DATE
REPAIR DATE
HOURS/MILEAGE
COMPLAINT & CAUSE
REPAIR
LABOR HRS.
TRAVEL HRS.
HR. RATE
PART DESCRIPTION
QTY
PART NO.
UNIT PRICE
TOTAL COST
TOTAL EXPENSES
LABOR
PARTS
MILEAGE
OTHER
TOTAL
MILES
@ $
$
$
$
$
$
APPLICATION
ASSEMBLY
SUB ASSEMBLY
DATE
FAILURE
CODE
CODE
CODE
CODE
SIGNATURE
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Parent category: Legal