WARRANTY CLAIM FORM
PLEASE COMPLETE ALL FIELDS AND RETURN TO HARVEST FOR REVIEW.
Mail: 2902 Expansion Blvd., Storm Lake, IA 50588 Email to: [email protected]
Customer Name:
Dealer Name:
Address:
Address:
City:
City:
Postal Code:
Postal Code:
Phone #
Phone #:
Email:
Email:
Name of person submitting claim: __________________________________________________ Date: _____________________
Model:
Date of Purchase:
Serial Number:
Date of Occurrence:
Warranty Claim Description of Issue:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Description of Repair Done by Dealer:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Labor Hours: __________ Rate: _____________ Mileage: _____________
Dealer WO (Must be attached): _____________________ Parts Required for Repair:
FOR OFFICE USE ONLY
Parts
Freight
Labor
Misc
Total Claim
Manager Approval: ___________________________________
Date Approved: _____________________________________
***All claims subject to Harvest approval. Please review our warranty policy before submitting.
Qty Harvest Part #
Invoice # (if known)
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Summary of Contents for H13104XT
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