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_NEW__WARRANTY_CLAIM_FORM.PDF
* CUSTOMERS NAME: _______________________________ * CLAIM DATE: _______________________ * CUSTOMERS ADDRESS: ________________________________________ * CITY: __________________ * STATE: __________ * ZIP ________________* CUSTOMER PHONE NUMBER: _____________________ * CONTRACTORS NAME: __________________________________________________________________ * CONTRACTORS ADDRESS: _______________________________________ * CITY: __________________ * STATE: __________ * ZIP: _______________ * CONTRACTORS PHONE#: _________________________ * UNIT MODEL NUMBER: ______________________ * UNIT SERIAL NUMBER: ____________________ * DATE OF UNIT INSTALLATION : ______________________ * DATE OF PART FAILURE : ______________________ * DATE OF PART REPLACEMENT : ______________________ * 1) PART NUMBER: _______________________ * DESCRIPTION OF PART: ________________________ * 2) PART NUMBER: _______________________ * DESCRIPTION OF PART: ________________________ * 3) PART NUMBER: _______________________ * DESCRIPTION OF PART: ________________________ * 4) PART NUMBER: _______________________ * DESCRITPION OF PART: ________________________ * CAUSE OF PART FAILURE : ___________________________________________________________ * MOTORS & COMPRESSORS, PLEASE PROVIDE NEW MODEL NUMBER: __________________________ * SERIAL NUMBER OF NEW COMPRESSOR OR COIL : ______________________________ * SERIAL NUMBER OF OLD COMPRESSOR OR COIL : _______________________________ * NEW PART PURCHASED INVOICE NUMBER: __________________ * INVOICE DATE: _______________ * LOCATION OF UNIT/JOB NAME: _______________________________________ * DEFECTIVE PART NUMBER: ___________________________________________ REFERENCE CLAIM#: ____________________ CREDIT INVOICE#: _______________________ CREDIT OTHER: _________________________ DEBIT INVOICE#: _____________________ CREDIT OTHER: _________________________ CLAIM ACCEPTED BY: ______________________ DATE: __________________________ ALL WARRANTY CLAIMS MUST BE SUBMITTED WITHIN 45 DAYS FROM THE DATE OF REPAIR. ** ONLY (4) PARTS ALLOWED PER WARRANTY CLAIM FORM ** www.admorhvac.com ** ALL (*) AREAS ON THIS CLAIM FORM NEEDS TO BE FULFILLED TO PROCEED WITH YOUR WARRANTY. THANK YOU. ** * FUJITSU CASE NUMBER: _______________________________ ** THIS PORTION TO BE COMPLETED BY ADMOR WARRANTY DEPARTMENT ** FAILURE TO DO SO WILL RESULT IN A WARRANTY CLAIM DENIAL. NO EXCEPTIONS. 815 Waiakamilo Road Honolulu, HI 96817 (808) 841-7400