WA R R A N T Y R E Q U E S T F O R M
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 unauthorized alteration has been made to this machine.
OPERATOR: SIGNATURE ________________________________ DATE: _____________________
OWNER: SIGNATURE
_________________________________
DATE:_____________________
OFFICE USE ONLY: ACCEPTED: YES/NO
DENIED:
YES/NO
DATE: ___________________________________ GOODS REPAIRED/ REPLACED/ REFUNDED FOR
DATE: _____________________________ REASON FOR DENIAL: _______________
CREDIT? (CIRCLE)
___________________________________
REFUND OR REIMBURSEMENT REQUIRED? _ CHQ NO/ ADJUSTMENT NOTE NO: ___________ SHIPPING DETAILS: _______________________ APPROVED BY: ___________________________
__________________________________
CHANGE REQUIRED? (CIRCLE)
DESIGN
WORK METHOD
ACTION TAKEN: ___________________________ SUPPLIED PRODUCT __________________________________________ REFER TO SUPPLIER CLIENT SATISFIED YES/NO RECALL REQUIRED
FILE CLOSED BY: _________________________
DATE: _____________________________
Fo l d i ng 3PL Speedt i l l er Power f l ex Ⓡ
Operator & Safet y Manua l
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