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}
Dates
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
{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}