Labor Reimbursement Form
Dealer Information:
Dealer _________________________________________________
Address _______________________________________________
City/State/Zip ___________________________________________
Country _______________________________________________
Phone #_______________________Fax # ____________________
E-mail ________________________________________________
On-site Information:
Customer Name _________________________________________
On-Site Location ________________________________________
Vehicle Make/Vessel Name ________________________________
Description of Fault or Complaint
___________________________
______________________________________________________
______________________________________________________
To be Completed By Servicing Dealer:
Date of Service ____________________________________________ Service Authorization #
(U.S. Only) ____ ____ ____ ____ ____ ____ ____
Invoice # _________________________________________________ ISN #__________________________________________________
Product Model ____________________________________________ Product Serial # _________________________________________
Install Date________________________________________________ Customer/Job Ref # ______________________________________
Conditions Found__________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Action Taken _____________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
# Used Shipped Part Description Part # Serial # Defective Serial # New Part
Labor _______ Hrs @ ______________/per hour Total Labor ________________
Total Labor Claim Requested: $
Travel_______ Hrs @ ______________/per hour Total Travel________________
By signing below, I declare the information on this form to be true to the best of my knowledge. I understand that any discrepancy found may effect the amount of this claim.
Technician/Dealer Signature ____________________________________________________________________________________
KVH Approval _______________________________________________________________________________________________
Terms and Conditions
KVH Technical Dealers are reimbursed for warranty work performed on KVH products in the field. The following guidelines have been established for the authorization and
compensation for work performed.
1. Authorization must be obtained from a KVH Technical Representative.
2. Dealers must have all necessary manuals and latest bulletins, the applicable parts, laptop, mobile phone, test equipment, and tools.
3. On-site time not to exceed two (2) hours without further approval.
4. Travel time not to exceed one (1) hour each way, and will be paid half (1/2) the labor rate.
5. Reimbursement is applied as a credit to the Dealer account.
6. Loaner or Units in Advance (UIA) must be returned within 15 days.
7. Claims older than 60 days will not be accepted.
8. KVH’s expectation is that all warranty service is complete and has solved the equipment problem.
9. Attach/fax any applicable service call reports with this form.
KVH Industries, Inc. • 50 Enterprise Center • Middletown, RI 02842-5279 • U.S.A. • Phone: +1 401 847-3327 • Fax: +1 401 845-8133
KVH Europe A/S • Kokkedal Industripark 2B • 2980 Kokkedal • Denmark • Phone: +45 45 160 180 • Fax: +45 45 1 6 0 1 8 1
© Copyright 2005, KVH Industries, Inc.
Subject to change without notice
S
O
Summary of Contents for TracVision A5
Page 1: ......