W ARRANTY C LAIM FORM LIPPERT COMPONENTS CUSTOMER

WARRANTY CLAIM FORM
Dealer Information
Dealer Name:
Contact:
Phone:Fax:
Cell:E-Mail:
City:State:
FID#:Zip:
RMA#:
Retail Customer Information
Retail Name:
Contact:
Phone: Fax:
Cell:
E-Mail:
Address:
City:
State:
Zip:
LIPPERT COMPONENTS CUSTOMER SERVICE
Address:
Contact us: Lippert Components Inc. - www.lci1.com/support - Phone: (574) 537-8900 - Email: [email protected]
Rev: 10.08.2015
Page 1
Warranty Claim Form updated 10-8-15
WARRANTY CLAIM FORM
Coach Information
Complete VIN:Model #:
OEM:DOM:
Make:DOP:
Claim Information
LIPPERT COMPONENTS CUSTOMER SERVICE
Parts Cost:Labor Time (Hrs):
Parts Markup:
Labor Rate (US $):
Freight Total:Total (Time X Rate):
Date of Repair:
Total = Parts + Labor + Freight:
***PARTS INVOICE MUST ACCOMPANY WARRANTY CLAIM***
Claim Description
LCI Warranty Claim Form MUST be filled out COMPLETELY and remitted with complete REPAIR
ORDER attached! Leaving ANY information blank delays the claim process and will result in
NON COMPENSATION for any and all parts, labor and freight.
Claim MUST be remitted by mail, fax or e-mail to [email protected] to be processed.
Claims remitted with returned parts will not be accepted. Unit Owner MUST Sign the LCI
WARRANTY CLAIM FORM. RO MUST accompany this form.
A W-9 form MUST be on file with LCI for the Warranty Dept. to process a claim. Please fill out
attached W-9.
RMA Number MUST be provided in the DEALER INFORMATION Section of this form. Claim will
be delayed without RMA#.
Signature
Date:
Please sign Warranty Claim Form above or provide a signed copy of the work order attached to this form.
Contact us: Lippert Components Inc. - www.lci1.com/support - Phone: (574) 537-8900 - Email: [email protected]
Rev: 10.08.2015
Page 2
Warranty Claim Form updated 10-8-15