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LAYMOR

Unit Warranty Claim Form / Field Service Report


Claimant Information
Company Name:
Address:
City:
State/Prov.:
Zip:
Contact:
Contact Title:
Phone:
Email Address:


Owner Information
Company Name:
Address:
City:
State/Prov.:
Zip:
Contact:
Contact Title:
Phone:
Email Address:


Unit Information
Serial Number:
Date In Service:
Hour Meter Reading:


Warranty Claim Information
Claim Number:
Date Repaired:
Labor Rate:


Details of Owner Complaint




What Failed Claim Information
Include description and part number. Parts must be itemized, numbered, and tagged for inspection by factory.
Description Part Cost Delete
Add Line Item
Part Cost (Claim) Total:

Service Work
Please include service work performed and description.

Description Labor Hrs. Delete
Add Line Item
Labor Hours (Claim) Total:

Credit Information
Issue:
Issue Credit/Check To:
Account Number:
Your Name: