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Winegard Company Warranty Claim Application

*Indicates Required Field
Download This Form

    RMA #:
Date
11/01/2014
 
Dealer Name:*
Dealer #:
Address:*
City:*
State/Province:*
Zip:*
Phone:*
Fax:*
Email:*
Work Order #* :
Date of Service:*
Technician:*
 
Customer Name:*
   
RV Make/Model/Year:    
Address:*
City:*
State/Province:*
Zip:*
Phone:*
Fax:
Email:
   
       
Product:*
Serial #:
Date of Purch.: *    
 
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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