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WARRANTY CLAIM FORMDate: Intitiator: Dealer Acct#: Batco Claim #:
Distributor Name: Distributor Claim #:
Dealer Name: Dealer Claim #:
Dealer Address: City State/Prov Zip/PC
Customer Name:
Customer Address: City State/Prov Zip/PC
YesNo
Dealer Signature: Date:
Part Number Qty
Warranty Approved
Y/N
Parts Total
Labor Performed By:
Rate/hr: Approved Amount
Dealer
Distributor
End User
Product Type Conveyed:
Approved by: Date:
BASE UNIT OF ATTACHMENT THAT FAILEDSerial Number:
Make & Model:
/ /
/ /
/ /Acres/Hrs Operated:
Date of Purchase: mm/dd/yy
Date of Failure: mm/dd/yy
Date of Repair: mm/dd/yy
Description
Total Amount Credited
Conveyor Registered?
DESCRIPTION OF FAILURE/REASON FOR CREDIT(DO NOT STATE DEFECTIVE)
Labor Total
Description:
WARRANTY LABORApproved Labor Hours
Rate Hrs
PARTS REPLACED(ITEMS MAY BE REQUIRED TO BE RETURNED TO FACTORY)
Claim Result:
Amount Approved for Warranty Credit
APPROVED PENDING DENIED
Claim form must be complete in full and submitted to Batco Mfg within 45 days of failure date.
Do not use shaded areas, for internal use only.
Type of Use: COMMERCIAL PRIVATE
Picture(s) included in claim? YES NO
Proof of purchase/other documents available if requested? YES NO
Was maintenance regularly performed as per operation manual? NOYES
DO NOT USE
DO NOT USE
DO NOT USE
Additional Information:
Claim form must be complete in full and submitted to Batco Mfg within 45 days of failure date.
Do not use shaded areas, for internal use only.
Batco201 Industrial Drive, Swift Current, SK S9H 5R4P: 877.667.7421 | F: 306.778.2524batcomfg.com
