Telsmith Warranty Claim Form

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Telsmith Warranty Claim Form Powered By Docstoc
					                                WARRANTY REQUEST FORM
                               Please complete as much information as possible on this form to substatiate your claim and submit via the methods
                               listed below. If you have any quesitons, Please contact Telsmith Service at 262-518-1300 or by the methods listed
                                                                                    below.
                                     * Indicates a required Field

                      All claims must be received by Telsmith no later than 30 days after the expiration of the warranty period. A Warranty
IMPORTANT             Registration Card must be on file at Telsmith before a warranty claim is processed. Authorize all returns prior to shipment.

                             New Equipment                                        Used / Rebuild Equipment
TYPE OF CLAIM*
                                Repair Parts
                     Dealer if Aplicable*                                                              END USER*
NAME                                                                   NAME
ADDRESS                                                                ADDRESS
CITY/STATE/ZIP                                                         CITY/STATE/ZIP
PHONE                                                                  PHONE
MAIN CONTACT                                                           MAIN CONTACT
EMAIL                                                                  EMAIL
DEALER CLAIM #
 MACHINE & MODEL NUMBER*                    DATE OF START-UP*              HOURS ON EQUIP.*                  RETURN GOODS NUMBER

EQUIPMENT SERIAL NUMBER*                     JOB ORDER NUM.                DATE OF FAILURE *                 DATE PARTS RETURNED

HAS THE WARRANTY REGISTRATION CARD BEEN SENT TO TELSMITH?
           YES                  NO
PARTS REPLACED
  QTY       PART                    DESCRIPTION                                                        ORDER INVOICE                    NET
          NUMBER                                                                                        NO.    NO.                    AMOUNT




                                                                                                    SUBTOTAL $                                       -
LABOR (Time Sheets with Detailed Explantion of Work Required)             MILEAGE (200 Miles Maximum)
  DATE    LABOR          RATE         ADJUSTMENT       TOTAL                  DATE     MILES    RATE  ADJUSTMENT                           TOTAL
          HOURS (O.T. Not Allowed) (Rate X 0.75)                                                                      (Rate X 0.50)

                                        $          -     $        -                                                   $          -     $             -
                                        $          -     $        -                                                   $          -     $             -
                                        $          -     $        -                                                   $          -     $             -
                                        $          -     $        -                                                   $          -     $             -
                                        SUB TOTAL $               -                                               SUB TOTAL $                        -
                                                                                                             CLAIM TOTAL $                           -
REASON FOR CLAIM* (EXPLAIN IN DETAIL, SECOND SHEET PROVIDED IF NEEDED)
PLEASE PROVIDE - CONCERN, CAUSE, CORRECTION (Below):




         DATE OF CLAIM*                                                SUBMITTED BY NAME*
          Telsmith Claim#
FORWARD CLAIMS TO:                                                      SUBMITTED BY EMAIL

            MAIL
            TELSMITH, INC.                              FAX                                           E-MAIL: (PREFERRED)
            10910 N INDUSTRIAL DRIVE
            ATTN: SERVICE DEPARTMENT                    (262) 518-1307                                CLAIMS@TELSMITH.COM
            MEQUON WI 53092                             SERVICE DEPT.
                                                                                                                                      Rev B. (6/2012)
CONCERN:




CAUSE:




CORRECTION:

				
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posted:8/31/2012
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