Warranty Claim Form for Customers
Service > Warranty claim form
Warranty Claim Form for CustomersService > Warranty claim form |
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Please print this form, then fax to 604-946-8524 when completed
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Customer & Claim Information |
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Customer Name |
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Address |
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Contact Name & Phone# |
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Date of Claim |
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Information on Failed Unit |
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Serial Number |
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Mfg & Model |
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Date unit went into service |
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Failure date |
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Repair completion date |
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Hours on Unit |
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Failed Unit is installed in |
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Serial Number |
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Mfg & Model |
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Failure Details |
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Describe the complaint, cause and corrective action
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Part no. & description of key part that caused failure |
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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 |
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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 |
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Manufacturer's Parts Used (use continuation sheets if required) |
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Quantity & Part# |
Description |
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Other Parts & Charges (Also fax receipts. Use continuation sheets if required) |
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Quantity & Part# |
Description & Cost |
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Labour (Use continuation sheets if required) |
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Hours |
Labour Code / Description |
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Claim Summary |
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Total Manufacturer's Parts Used |
$ |
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Total Other Parts & Charges |
$ |
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Labour chargeout rate |
$ |
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Re & Re Hours |
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Travel Hours |
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Total Labour Hours |
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Km Travelled |
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Claim Total (excluding GST) |
$ |