Warranty Claim Form - AG SHIELD Flexicoil PT Operator’s Handbook And Parts Manual

6.1 WARRANTY CLAIM FORM

Dealer
Address
City State/Province
DATE OF SALE DATE FAILED
LABOUR HOURS LABOUR RATE
QUANTITY PART DESCRIPTION
ITEM NUMBER
1
2
3
4
5
6
7
8
I CERTIFY THAT THE INFORMATION IS ACCURATE AND
THAT THE PARTS WERE REPLACED ON THE MACHINE
SHADED AREAS AG SHIELD USE ONLY ---PLEASE ADD DETAILS FOR ITEM NUMBERS ON BACK
Ag Shield Mfg
Box 9, Benito,
MB, R0L 0C0
ph 800-561-0132
fax 204-539-2130
ph 204-539-2000i
Zip/Postal
REPAIR DATE ACRES/HOURS
LABOUR AMOUNT PARTS MUST BE RETURNED TO BENITO MB FREIGHT PREPAID TO BE
CONSIDERED FOR WARRANTY.
PRICE TOTAL
EACH PRICE
PARTS
LABOUR
TOTAL
End User
Address
City State/Province
MODEL
DATE SHIPPED
DESCRIBE THE CAUSE OF FAILURE
AND CORRECTIVE ACTION TAKEN
DATE PARTS RECD
ITEMS TO SUPPLIERS
Zip/Postal
SERIAL NUMBER
APPROVE
/REJECT
RECD BY
33