Warranty Claim - Winegard

Winegard Company - Warranty Claim Application

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Warranty Claim Application
*Indicates Required Field

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RGM/RA #:

Date

03/12/2010

Dealer Name:*

Dealer #:

Address:

City:

State/Province:

Zip:

Phone:*

Fax:*

Email:

Work Order #* :

Date of Service:*

Technician:

Customer Name:*

RV Make/Model/Year:*

Address:

City:

State/Province:

Zip:

Phone:*

Fax:

Email:

Product:*

Serial #:

Date of Purch.: *

Description of Problem: *

Diagonosis:

Corrective Action:

Additional Materials:

Qty:	Part #	Description	Cost	Parts Returned Y/N

Labor
Est. Labor Hours: @ $ per hour.

Miscellaneous Charges

Shipping Method:

Cost:

Other Charges:

Tax:

Total Charges:

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Winegard Company is the leading manufacturer of television reception products including over-the-air vhf, uhf, indoor and outdoor hdtv home antennas, mobile satellite antennas, portable automatic satellite antennas, rear-seat atsc m/h systems, extended range mobile internet broadband systems, home satellite dishes and medical telemetry technology.
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