WARRANTY CLAIM FORM
PLEASE COMPLETE ALL FIELDS AND RETURN TO HARVEST
International
. FOR REVIEW.
Mail:
2902 Expansion Blvd.
Storm Lake, IA 50588
Email t
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
by Meridian
approval. Please review our warranty policy before submitting.
Qty
Harvest
Part #
Invoice # (if known)
Summary of Contents for H1384XT
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