warranty claim form

Customer Name (First & Last)

Customer Address

Street, City, State & Zip Code

Dealer Name

Supply specific location if dealer has multiple locations

Name of Person Submitting Claim

Select Model

If Other, Please Specify:

Purchase Date

YYYY

Serial Number

Date of Occurrence:

Tell us when the issue began.

Description of Issues:

Description of Repair Done by Dealer:

Labor Hours Performed by Dealer:

Mileage (if any)

Dealer Labor Rate

Do you need to return defective or damaged parts?

By selecting "Yes", this will let us know to supply you with an RMA number.

Yes

List Part Numbers To Be Returned:

Please enter part numbers only. Make sure to include the quantity to be returned in parenthesis following the part number.

Parts Order Number:

When ordering parts to repair, please provide the Parts Order Number assigned by Harvest International Parts Personnel at time of ordering.

MANUFACTURED

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