Detach and send with unit.
Crown Factory Service Information
Shipping Address: Crown International, Inc., Factory Service, Plant 2 SW, 1718 W. Mishawaka Rd., Elkhart, IN 46517
Phone: 1-800-342-6939 or 1-219-294-8200   Fax: 1-219-294-8301
Owner’s Name: _________________________________________________________________________
Shipping Address: ______________________________________________________________________
Phone Number: _____________________________ Fax Number: _____________________________
Model: ________________________ Serial Number: ______________ Purchase Date: ___________
NATURE OF PROBLEM
(Be sure to describe the conditions that existed when the problem occurred and what attempts were made to correct it.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Other equipment in your system: _________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
If warranty has expired, payment will be:
   ❏   ❏
   ❏   ❏
   ❏ Cash/Check 
❏❏
❏❏
❏ VISA 
❏❏
❏❏
❏ MasterCard 
❏❏
❏❏
❏ C.O.D.
Card Number:___________________________   Exp. Date:_______  Signature:____________________________
ENCLOSE THIS PORTION WITH THE UNIT. DO NOT MAIL SEPARATELY.