Coaire SCROLL CSOF-M3PL/H12 - Warranty Claim Report

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Warranty Claim Report
Please complete the following claim form, your claim will be confirmed by our sales representative.
To : Coaire, Division of Quietside
8750 Pioneer Blvd., Santa Fe Springs, CA 90670
Tel(562)576-1330.Fax(562)699-4351 email: support@coaire.com
Distributor
Company
Date
Address
Model
Serial No.
Customer
Company
Run Hours
Hrs.
Address
Setting Press.
PSIG
OPERATING CONDITIONS
Percent(%) on load
%
Ambient Temperature
·
F
No. of days of operation weekly
Days
Discharge temperature
·
F
Hours per day
Hours
Compressor area temperature
·
F
Machine setting OL/OL or Mod
Enviro
nment
1)
1) 1 to 10, 1 being clean, 10 very dirty
Incoming Voltages
Full load amperage at _______ PSIG
Unload amperage at ______ PSIG
L1
-
L2
L2
-
L3
L1
-
L3
L1
-
L2
L2
-
L3
L1
-
L3
L1
-
L2
L2
-
L3
L1
-
L3
Volts
Volts
Volts
Amp.
Amp.
Amp.
Amp.
Amp.
Amp.
Symptom
Fault Diagnosis
Resolution
Parts required Labor Cost
No.
Item Number
Description/MFGR Part Number
Quantity
Labor Time: Hrs x
$/Hrs= $
01
Travel Time:
Hrs x $/Hrs=
$
02
Total
Amount:
03
04
Technician
’
s
name:
WRITTEN BY SIGNATURE X