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WARRANTY CLAIM FORM
Warranty Providers Name: Coast RV Pty Ltd trading as Coast to Coast RV Services
ABN 49 097 104 492 - ACN 101 461 330
Warranty Providers Address: PO Box 6287, Silverwater NSW 1811 Australia OR;
PO Box 58-054 Botany AUCKLAND 2163 New Zealand
Client:
Description of Goods provided:
Receipt enclosed: (tick box) Yes No
Description of defects (Give as
much detail as possible. Use a
separate page if required):
Date of purchase/services
provided:
I hereby declare that the information provided above is true and correct and to the best of my knowledge and belief
and I have complied with all the conditions of the warranty.
Signed:.....................................................................
Name: ......................................................................
(please print)
Dated: ......................................................................
[Please note, the issue or completion of this form by the Client does not constitute an admission of liability by the Supplier]
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