Report-of-Warranty

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Service Center Information

Service Center Name

Account #

Date Requested

Requested By

Requester Email

Customer Information

Name

Address 1

Address 2

City

State

Zip Code

Phone Number

Service Description

Date IN

Date OUT

Model Number

Serial Number/Date Code

Condition of Unit

New

Slight Use

Moderate Use

Heavy Use

Explanation of Failure (Provide detail including Part Numbers)

Claim Item 1

List the information below for the part used in repair.

Part Number 1

Quantity

TSC Cost

TOTAL

Claim Item 2

Part Number 2

Quantity

TSC Cost

TOTAL

Claim Item 3

Part Number 3

Quantity

TSC Cost

TOTAL

Claim Item 4

Part Number 4

Quantity

TSC Cost

TOTAL

Expenses

Hours of Labor

Rate Per Hour

Labor Total (Hours x Rate)

Total Parts Cost:

Parts Cost x 10% Handling

Shipping Cost

TOTAL CREDIT REQUESTED

Report of Warranty

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