Thank you, {First Name:77}.

You have successfully submitted your Pierce Warranty Claim. Please print and save a copy of the information below for your records. Pierce’s Warranty Administrator will contact you soon.

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Pierce Support Team

Warranty Claim Summary Details

PIERCE CLAIM NUMBER: {Pierce Claim Number:1}
DEALER CLAIM NUMBER: {Dealer Claim Number:170}
DATE: {Date:2}
Dealer Contact Information

NAME: {First Name:14} {Last Name:15}

COMPANY: {Company:12}

PHONE: {Phone:16}

FAX: {Fax:17}

EMAIL: {Email:171}

End User Contact Information

NAME: {First Name:6} {Last Name:7}

COMPANY: {Company:8}

PHONE: {Phone:9}

FAX: {Fax:10}

EMAIL: {Email:172}


START UP DATE: {Start Up Date:18}

FAILURE DATE: {Failure Date:19}

REPAIR DATE: {Repair Date:20}

Product Information

PIERCE PRODUCT MODEL NUMBER: {Pierce Product Model Number:173}

PIERCE PRODUCT SERIAL NUMBER: {Pierce Product Model Serial Number:174}

MACHINE MAKE: {Machine Make:24} MACHINE MODEL: {Machine Model:25} MACHINE SERIAL #: {Machine Serial Number:26}

HOURS: {Hours:27}

COMPLAINT / PROBLEM: {Complaint / Problem:29}

Claim Material
Item 1 Details

PART #: {Item 1 Part #:43} DESCRIPTION: {Item 1 Description:129}

QUANTITY: {Item 1 Quantity:175} PRICE PER ITEM: {Item 1 Price per Item:176} TOTAL AMOUNT: {Item 1 Total Amount:47}

Item 2 Details

PART #: {Item 2 Part #:130} DESCRIPTION: {Item 2 Description:133}

QUANTITY: {Item 2 Quantity:177} PRICE PER ITEM: {Item 2 Price per Item:177} TOTAL AMOUNT: {Item 2 Total Amount:134}

Item 3 Details

PART #: {Item 3 Part #:55} DESCRIPTION: {Item 3 Description:138}

QUANTITY: {Item 3 Quantity:179} PRICE PER ITEM: {Item 3 Price per Item:180} TOTAL AMOUNT: {Item 3 Total Amount:59}

Item 4 Details

PART #: {Item 4 Part #:140} DESCRIPTION: {Item 4 Description:143}

QUANTITY: {Item 4 Quantity:181} PRICE PER ITEM: {Item 4 Price per Item:182} TOTAL AMOUNT: {Item 4 Total Amount:65}

Item 5 Details

PART #: {Item 5 Part #:89} DESCRIPTION: {Item 5 Description:147}

QUANTITY: {Item 5 Quantity:183} PRICE PER ITEM: {Item 5 Price per Item:184} TOTAL AMOUNT: {Item 5 Total Amount:112}

Item 6 Details

PART #: {Item 6 Part #:148} DESCRIPTION: {Item 6 Description:152}

QUANTITY: {Item 6 Quantity:185} PRICE PER ITEM: {Item 6 Price per Item:186} TOTAL AMOUNT: {Item 6 Total Amount:111}

Item 7 Details

PART #: {Item 7 Part #:93} DESCRIPTION: {Item 7 Description:156}

QUANTITY: {Item 7 Quantity:187} PRICE PER ITEM: {Item 7 Price per Item:188} TOTAL AMOUNT: {Item 7 Total Amount:110}

{Materials Subtotal:66}
Claim Labor

LABOR HOURS: {Labor Hours:69}

LABOR RATE: {Labor Rate:162}

TOTAL LABOR COST: {Total Labor Cost:73}

Additional Expenses

TOTAL AMOUNT: {Additional Expenses:166}

DESCRIPTION: {Briefly describe additional expenses:168}

Claim Total

{Claim Total:75}

Submitted By

NAME: {First Name:77} {Last Name:78}

EMAIL: {Email:169}