Heavy Construction

Customer Services

JRB Warranty Claim Form

Warranty Claim Form

DEALER INFORMATION

Dealer Name:		Attn.:
Address		Phone
		Fax
Email
Dealer Claim Number:

COUPLER OR ATTACHMENT INFORMATION

Serial #		PCN #		Hours
Machine Model:		Application :		RGA #
Failure Date:				Repair Date:

Details of Failure
Corrective Action:

Total Labor Hours	Total Labor Cost	Freight	Misc. & Outside Cost

Part Number	Dealer Part Number	QTY	Description	Cost





			Total Parts Cost
			Total Claim Cost

Attachments (limited to 10MB)

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