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Warranty Claims
Warranty Claim Application
Date:
02/22/2019
RMA #:
Dealer Details
Dealer Name:*
Dealer #:
Work Order #:*
Technician:*
Address:*
City:*
Date of Service:*
State/Province:*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
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MO
MS
MT
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NH
NJ
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OK
OR
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--Canada--
AB
BC
MB
NB
NL
NS
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ON
PE
QC
SK
YK
--Australia--
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Zip:*
Phone:*
Fax:*
Email:*
Customer Details
Customer Name:*
RV Make/Model/Year:
Product:*
Serial #:
Address:*
City:*
Date of Purch.: *
State/Province:*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
--Canada--
AB
BC
MB
NB
NL
NS
NT
ON
PE
QC
SK
YK
--Australia--
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Zip:*
Phone:*
Fax:
Email:
Description of Problem: *
Diagonosis:
Corrective Action:
Additional Materials:
Qty:
Part #
Description
Cost
Parts Returned
Y/N
Labor
Est. Labor Hours:
@ $
per hour.
Miscellaneous Charges
Shipping Method:
Cost:
Other Charges:
Tax:
Total Charges:
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