Warranty Claim Form for Dealers
Service > Dealer warranty > Dealer claim form
Warranty Claim Form for DealersService > Dealer warranty > Dealer claim form |
|
|||||||
|
|
||||||||
Please print this form, then fax to 604-946-8524 when completed
|
Dealer, End User & Claim Information |
|
|
Dealer |
|
|
City |
|
|
Your name |
|
|
Your Ref # |
|
|
End User |
|
|
Address |
|
|
Date of Claim |
|
|
Information on Failed Unit |
|
|
Serial Number |
|
|
Mfg & Model |
|
|
Date unit went into service |
|
|
Failure date |
|
|
Repair completion date |
|
|
Hours on Unit |
|
|
Failed Unit is installed in |
|
|
Serial Number |
|
|
Mfg & Model |
|
|
Failure Details |
|
|
Describe the complaint, cause and corrective action
|
|
|
Part no. & description of key part that caused failure |
|
|
Cause of Failure: _____ |
A-weak material; B-weak weld; C-part made wrong; D-welded wrong; E-assembled wrong;F-foreign material; G-casting deficiency; Z-other/unknown |
|
Type of failure: _____ |
01-bent/twisted; 02-blown; 03-broke/cracked; 04-burned out/up; 05-came loose/off; 06-corroded/pitted; 07-electrical failure; 08-lack of power; 09-leaked; 10-oil consumption; 11-pin hole/porous;12-pressure low/high; 13-scored/grooved; 15-stripped; 16-stuck/seized; 17-improper fit; 18-premature wear; 19-slipping; 99-other |
|
Manufacturer's Parts Used (use continuation sheets if required) |
|
|
Quantity & Part# |
Description |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other Parts & Charges (Also fax receipts. Use continuation sheets if required) |
|
|
Quantity & Part# |
Description & Cost |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Labour (Use continuation sheets if required) |
|
|
Hours |
Labour Code / Description |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Claim Summary |
|
|
Total Manufacturer's Parts Used |
$ |
|
Total Other Parts & Charges |
$ |
|
Labour chargeout rate |
$ |
|
Re & Re Hours |
|
|
Travel Hours |
|
|
Total Labour Hours |
|
|
Km Travelled |
|
|
Claim Total (excluding GST) |
$ |