IQR / Warranty Form

WARRANTY CLAIM / INITIAL QUALITY REPORT FORM

*indicates required fields

IQR: Use this button in order to request- Spare parts warranty/ Spare parts return/ Parts mis-shipment corrections/ Advise quality department of concerns in the field

Warranty: Use this button in order to request- Reimbursement for repair of original machine components

*Person completing this form :

*Email :

If email is same as in Service
Center Information

*Status update notifications related to this
form will be emailed to this address

* Please select one :

IQRWARRANTY

Machine Information

* Machine SAP# : (First 8 digits in serial #)
* Machine Complete Serial# :
* Date Code (XXXX) : (4 digits located on serial plate under bar code)
* Sales Order # or Invoice# :	(PO # is not accepted)
* Machine Sold Date :
* Repair Date :

Service Center Information

* Service Center :
* Customer#:
* Address :
* City :
* State / Province :
* Zip / Postal Code :
* Phone :
* Fax :
* Email :

Customer Information

Check If Customer Information is the same as Service Center Information
* Customer Name :
* Attention :
* Address :
* City :
* State / Province :
* Zip / Postal Code :
* Phone :

Claim Details & Job Information

* Description Of Failure, Including All Relevant Part Numbers (please fill out for IQR / Warranty Claim) :

Warranty / IQR Information

Part#	Defect Code	Description	Qty.	Dealer Cost
				$ Ea
			Add New Row	Remove Row

Labor Ops Number	Labor Description	Labor Hrs.	Labor Rate
0303	Labor		$60 per hr.
Travel Ops Number	Travel Description	Travel Hrs.	Travel Rate
0301	Travel (Stationary Equipment Only)		$60 per hr.
Diagnostics & Admin Ops Number	Diagnostics & Admin Description	Diagnostics & Admin Hrs.	Diagnostics & Admin Rate
0302	Diagnostics & Admin		$60 per hr.
		Freight	$

IQR / Warranty Form