Warranty claim form

Warranty Claim Form

"*" indicates required fields

Submitter Name*

First Last

Submitter Phone Number

Submitter Email*

Reference Number*

Failed Parts Returned to Trimax*

Yes

Corrective Action Taken*

Parts Information

Quantity

Part Number

Description

Price

Eg. Qty: 1 | Part Number: 504-000-133 | Description: Spindle | Price: 850.76

Freight Amount

Labour Hours

Labour Rate

Trimax Sales Order Number (If known)

Total Claim Amount

I hereby certify this info is correct and true - First and Last Name*