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Agline Equipment

WARRANTY CLAIM FORM

1600 N. Pearl Street, Carthage MS 39051

Phone: (601)-572-4237

IMPORTANT

    1. Claim must be submitted within 30 days of failure
    2. Fill out one claim form for each unit
    3. Hold parts at Dealer for disposition instructions
MM slash DD slash YYYY
(Required)
DISTRIBUTOR OR DEALER NAME:
DISTRIBUTOR OR DEALER ADDRESS
CUSTOMER NAME
CUSTOMER ADDRESS

BASE UNIT OR ATTACHMENT THAT FAILED

MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
DEALER SIGNATURE

PARTS REPLACED

(ITEMS CHECKED MUST BE RETURNED TO FACTORY)
PARTS REPLACED
QUANTITY
PART NUMBER
DESCRIPTION
 
COMPANY USE ONLY
WARRANTY APPROVED
CHECKMARK
AMOUNT
 

WARRANTY LABOR (COMPANY USE ONLY)

RETURN PARTS BY: