FORM – Beaver Valley Supply

WARRANTY CLAIMS AND RETURN FORM

DEALER INFO

DATE *

CLAIM#

MANUFACTURER *

DEALER WORK ORDER#

DEALER *

CONTACT *

ADDRESS *

CITY *

STATE *

ZIP *

DATE PURCHASED *

INVOICE *

SERIAL# *

MODEL# *

Phone # *

Email *

END USER INFO

CUSTOMER NAME

ADDRESS

DATE OF PURCHASE

FAILURE DATE *

DATE OF REPAIR *

HOURS OF OPERATION

MODEL OF TRACTOR

WARRANTY

NEW

PARTS USED TO MAKE REPAIRS

QUANTITY

PART #

DESCRIPTION

INV#

AMOUNT

HOURS OF LABOR

RATE

PARTS

LABOR

FREIGHT

TOTAL

RETURN / WARRANTY REASONING

DESCRIPTION OF REPAIRS OR REASON FOR RETURN *

SIGNATURE *

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FOR BEAVER VALLEY USE ONLY

BEAVER VALLEY SUPPLY INC

P O BOX 419

21366 HWY 36

E-MAIL: cory@beavervalleysupply.com

ATWOOD KS 67730

PH 800-982-1280

FAX 800-536-6263

DATE RECEIVED AT BEAVER VALLEY

DELIVERY RECEIPT #

RETURNED BY IC X

DATE RETURNED TO MANUFACTURER

DELIVERY RECEIPT #------RGA #

RETURNED BY

CREDIT INVOICE #

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