Winegard --- Contact Us

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1-800-288-8094

Winegard Company
3000 Kirkwood St.
Burlington, IA 52601

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Warranty Claim Application

*Indicates Required Field

RGM/RA #:

Date

07/25/2008

Dealer Name:*

Dealer #:

Address:

City:

State:

Zip:

Phone:*

Fax:*

Email:

Work Order #* :

Date of Service:*

Technician:

Customer Name:*

RV Make/Model/Year:*

Address:

City:

State:

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: