JRB

Paladin - Demolition / Recycling / Forestry

For the convenience of our patrons, we are providing this electronic claim form for instant submission of warranty claims. If you would prefer to download a faxable copy of the claims form, click here.

* Denotes required fields.

* Dealer Name:

* Attn:

* Address:

* City:

* State:

* Zip:

* Phone:

* Fax:

* Email:

* JRB Serial #:

* HRS (on attachment):

* RGA#:

* JRB Attachment Desc:

* Repair Date:

* Machine Model:

* Failure Date:

* Application:

* Details of Failure:

* Corrective Action:

* Total Labor Hours:

* Total Labor Costs:

* Freight:

* Dealer Invoice No:

* Misc Costs - i.e. outside Costs
(Submit Service Invoice along with Supporting Documentation):

Qty:	Part #:	Description:	Cost:





		Total Parts Cost:
		Total Claim Cost:

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