Warranty Claim Form
All fields must be completed or claim will be denied.                                      
Date:                                                  
                                                             
Warranty Claim No.                                              
Customer/Dealer Information  
Dealer ID:                                              
Name:  
Address:  
City:   St:   Zip:  
Phone:   Fax:    
Applicant:   Signature:  
Manager:   Signature:  
                                                             
Machine  Information  
Product:   Model:  
Serial#   Hours:  
Date of Commissioning   Report Date:  
Description of failure:
 
                                                             
LABOR
Date From / to Travel From/to Mileage Labor Lodge Meal Others Cost
              $
              $
PARTS
Qty Part number Description Invoice # Unit Cost Total Cost
      $
 
Total labor cost of repairs work only:   Labor Cost
Total cost of part(s) used in repairing unit:   Parts Cost
Total amount claimed, parts and labor combined:   Total Cost
Please Submit to: warranty@sanyamerica.com                                          
Service Manager:   Comments:  
Service & Parts Dept.:   Comments:  
Financial Dept.:   Comments:  
Presidents office use only  
Claim:   Approved   Not Approved   President approval: Yes No Date:
Comments:  
 
 

318 Cooper Circle South | Peachtree City, GA 30269  | Tel: 678-251-2810  | Fax: 770-631-7731