AG SHIELD Flexicoil PT - Warranty Claim Form

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6.1 WARRANTY CLAIM FORM
Dealer Ag Shield Mfg End User
Box 9, Benito,
MB, R0L 0C0
Address ph 800 - 561 - 0132 Address
fax 204 - 539 - 2130
ph 204 - 539 - 2000i
City State/Province Zip/Postal City S tate/Province Zip/Postal
DATE OF SALE DATE FAILED REPAIR DATE ACRES/HOURS MODEL SERIAL NUMBER
LABOUR HOURS LABOUR RATE LA BOUR AMOUNT PARTS MUST BE RETURNED TO BENITO MB FREIGHT PREPAID TO BE
CONSIDERED FOR WARRANTY. DATE SHIPPED
QUANT ITY
ITEM
PART
NUMBER
DESCRIPTION PRICE
EACH
TOTAL
PRICE
DESCRIBE THE CAUSE OF FAILURE
AND CORRECTIVE ACTION TAKEN
APPROVE
/REJECT
1
2
3
4
5
6
7
8
I CERTIFY THAT THE INFORMATION IS ACCURATE AND PARTS DATE PARTS RECD RECD BY
THAT THE PARTS WERE REPLACED ON THE MACHINE
LABOUR ITEMS TO SUPPLIERS
TOTAL
SHADED AREAS AG SHIELD USE ONLY --- PLEASE ADD DETAIL S FOR ITEM NUMBERS ON BACK