All warranties must be submitted to: CARSWELL DISTRIBUTING CO. P.O. Box 4193 Winston-Salem, NC 27115 Phone (800) 929.1948 FAX (877) 929.1949 [email protected]

WARRANTY REQUEST FORM NOTE: Rounded corner areas, factory use only. #________________ CLAIM DATE _____/_____/_____

DEALER______________________________________________________

CUSTOMER____________________________________________________

ADDRESS_____________________________________________________

ADDRESS______________________________________________________

CITY_________________________________________________________

CITY___________________________________________________________

STATE_________________________________ZIP____________________

STATE________________________________ZIP______________________

DEALER SIGNATURE__________________________________________________ DEALER PHONE # (

)___________________________________

PRODUCT INFORMATION MODEL NUMBER______________________________________________

DISTRIBUTOR / PRE-APPROVAL DISTRIBUTOR___________________________________________________

SERIAL NUMBER______________________________________________

ADDRESS______________________________________________________

DATE OF SALE________________________________________________

CITY___________________________________________________________

FAILURE DATE________________________________________________

STATE_________________________________ZIP_____________________

HOURS @ FAILURE____________________________________________

AUTHORIZATION SIGNATURE_____________________________________

DETAILED DESCRIPTION OF FAILURE_______________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________

 

TYPE OF WARRANTY





ORIGINAL EQUIPMENT

ITEM

PART NUMBER

POLICY ADJUSTMENT

KEY PART__________________________________ FAIL CODE_________________________________

DEFECTIVE SERVICE PARTS

DESCRIPTION

QTY

F/R*

PARTS PRICE

1 2 3 4 5 6 7 8 9 10 SHOP RATE $ DATE____________________

*F/R = FLAT RATE REPAIR TIME



APPROVED



RETURNED

TOTAL HOURS =



DISALLOWED

COMMENTS________________________________________________________________________________ __________________________________________________________________________________________

%

PARTS CREDIT LABOR CREDIT

__________________________________________________________________________________________

OTHER CREDIT

PROCESSING SIGNATURE___________________________________________________________________

TOTAL CREDIT

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