SUBURBAN MANUFACTURING COMPANY
676 Broadway Street
Dayton, Tennessee 37321
423-775-2131
www.RVComfort.com
WARRANTY SERVICE CLAIM FORM
ALL SHADED AREAS MUST BE FILLED IN WITH THE CORRECT INFORMATION!
SERVICE COMPANY TELEPHONE NO.
ADDRESS
CITY AND STATE ZIP CODE
CUSTOMER NAME TELEPHONE NO.
ADDRESS
CITY AND STATE ZIP CODE
SERVICE COMPANY
WORK ORDER NUMBER
SUBURBAN MFG. CO.
CLAIM NUMBER
APPLIANCE MODEL NUMBER:
SERIAL NUMBER:
PURCHASE DATE:
VEHICLE MANUFACTURER: VEHICLE MODEL:
VEHICLE ID NUMBER:
DATE SERVICE REQUESTED:
WARRANTY AUTHORIZATION NUMBER:
DATE SERVICE COMPLETED:
DIAGNOSIS AND SERVICE PERFORMED
COMPLAINT:
SERVICE PERFORMED:
PARTS USED FOR REPAIR
PART NUMBER DESCRIPTION
INSTRUCTIONS FOR DEFECTIVE PARTS RETURNS:
FLAT RATE TIME:
LABOR AMOUNT:
$
TOTAL:
$
TECHNICIAN SIGNATURE DATE
CUSTOMER SIGNATURE/COMPANY NAME
IF NOT ORIGINAL APPLIANCE OWNER
DATE
CHECK ONE
□ APPLIANCE WAS INSTALLED BY AN RV MFG (OEM)
□ APPLIANCE PURCHASED FROM AFTERMARKET
All water heaters, module boards, motors, valves, electric elements, and combustion
chambers must be properly tagged and returned for factory inspection within 60
days. The labor claim should be returned with these parts.
All other parts may be eld scrapped - please mark on the claim form that the part was
“Field Scrapped”. Field scrapped parts should be held until the claim is approved by
the factory.
DO NOT SUBMIT INVOICE UNTIL SERVICE IS COMPLETE.
Please retain a copy of this form.