Winegard Company - Warranty Claim Application
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  • Warranty Claim Application

    • *Indicates Required Field

    Download This Form

        RGM/RA #:
    Date
    		 11/07/2009
    		 
    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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