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DEALER INFORMATION
Today's Date:   02-09-2012
*Dealer:
Contact:
Address:
Address:
City:
State:
Zip:
*Phone:
Email:
 
EQUIPMENT/WARRANTY INFORMATION
Serial Number:
Failure Date: (mm/dd/yyyy)
Reported On: (mm/dd/yyyy)
 
Manufacturer:
Model Number:
Work Order Number:
 
CLAIM INFORMATION
Hours @ Breakdown:
 
Labor Total Hours:
Hourly Rate:$
 
Labor Cost:$
Parts Total:$
Other Charge (1):$
Other Charge (2):$
 
Total Claim:$
 
DETAILS
Customer Complaint:
Cause of Failure:
Corrective Action:
 
FILE ATTACHMENTS
File: 
File: 
File: 
File: 
 
CLAIM GUIDELINES
1.) Attach work order
2.) Invoice should include number of hours and labor rate for each operation.
3.) Environmental charges, Freight charges, shop supplies are not covered.
4.) If parts are over $1,000.00, pictures of the failed parts must be included.
5.) If claim is over $5,000.00 contact Glynn General before proceeding with repair.
6.) All old parts should be retained for 30 days after claim is received by Glynn General, in case we need to inspect them.
7.) Claim Fax # 912-638-5931 | Email
Please type the text below in the textbox
 E8BlEy
 
All claims are paid in US Dollars


 

© 2012
Ag Guard LLC
21295 Hollingsworth Road
Tonganoxie, KS 66086

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