WARRANTY REQUEST FORM RESELLER: _______________________ CLIENT: ______________________ ADDRESS: _______________________
_____________________________
PHONE: _________________________ _____________________________ MACHINE MAKE & TYPE: ____________________________________________ SERIAL NO: ______________________ CUSTOMER ORDER NO: _______ INVOICE NO: _____________________ DATE OF INVOICE: ___________ FULL DESCRIPTION: ________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ CAUSE: ____________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ DATE OF FAILURE: _______________ HOURS WORKED: _____________ DATE OF REPAIR: ________________ HECTARES WORKED: _________ I AGREE: 1. That in accordance with the warranty given by K-LINE AGRICULTURE, I have taken every reasonable precaution as is commonly expected in this industry in the operation of the machine. 2. This claim is not due to negligence, lack of maintenance, routine wear & tear or accidental damage & no unauthorised alteration has been made to this machine. OPERATOR: SIGNATURE ________________________________ DATE: _____________________________________________ OWNER: SIGNATURE _________________________________ DATE: _____________________________________________ OFFICE USE ONLY: ACCEPTED: YES/NO DENIED: YES/NO DATE: ___________________________________ DATE: _____________________________ GOODS REPAIRED/ REPLACED/ REFUNDED FOR REASON FOR DENIAL:
_______________ CREDIT? (CIRCLE)
___________________________________ ___________________________________
REFUND OR REIMBURSEMENT REQUIRED? CHQ NO/ ADJUSTMENT NOTE NO: ___________ SHIPPING DETAILS: _______________________ APPROVED BY: ___________________________ ACTION TAKEN: ___________________________ _________________________________________
CHANGE REQUIRED? (CIRCLE)
DESIGN
WORK METHOD
SUPPLIED PRODUCT REFER TO SUPPLIER RECALL REQUIRED
CLIENT SATISFIED
YES/NO
FILE CLOSED BY: _________________________
DATE: _____________________________
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