Warranty

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WF-411REV2 Warranty Claim Application

Page 1 of 3

WARRANTY CLAIM APPLICATION

1. RGM/RMA #:

DISTRIBUTOR INFORMATION

(Skip this section if claim is originating from a Dealer or Consumer)

2. Distributor Name: 3. Account #:

4. Street Address: 5. City: 6. State: 7. Zip:

8. Phone: 9. Fax: 10. E-Mail:

DEALER INFORMATION

(Skip this section if claim is originating from a Consumer)

11. Dealer Name: 12. Dealer #:

13. Street Address: 14. City: 15. State: 16. Zip:

17. Phone: 18. Fax: 19. E-Mail:

20. Work Order #: 21. Date of Service: / / 22. Technician:

CONSUMER INFORMATION

23. Consumer Name:

24. (Skip this item if Consumer is not a Mobile Customer)

RV Brand/Model/Year:

25. Street Address: 26. City: 27. State: 28. Zip:

29. Phone: 30. Fax: 31. E-Mail:

32. Winegard Product Model: 33. Serial #: 34. Date of Purchase: / /

PROBLEM INFORMATION

35. Description of Problem:

36. Diagnosis:

37. Corrective Action:

38. Materials

Qty Part # Description Cost

Parts Returned

Y N

Total Material Charges

39. Labor hrs @ $ per hour Total Labor Charges $ FOR WINEGARD USE ONLY

40. Shipping Charges Shipping Method

UPS FEDEX OTHER

$ Call #

41. Miscellaneous Charges

RMA #

Tax

Explanatio

Shipment #

Other Charges

Explanatio

Claim #

42. Total Charges $

Fax to: (319) 754-0715 E-mail to:Warranty@winegard.com

Authorized by

Mail to: Technical Services, Winegard Company, 2736 Mt. Pleasant Street, Burlington, IA 52601

Date

In order to process your claim the Consumer proof of purchase documentation is required to be sent to

Winegard Company along with the product and this completed warranty claim application.

Ref. RMA #

Summary of content (3 pages)

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WARRANTY CLAIM APPLICATION 1. RGM/RMA #: DISTRIBUTOR INFORMATION (Skip this section if claim is originating from a Dealer or Consumer) 2. Distributor Name: 3. Account #: 4. Street Address: 5. City: 8. Phone: 6. State: 9. Fax: 7. Zip: 10. E-Mail: DEALER INFORMATION (Skip this section if claim is originating from a Consumer) 11. Dealer Name: 12. Dealer #: 13. Street Address: 14. City: 17. Phone: 15. State: 18. Fax: 20. Work Order #: 16. Zip: 19. E-Mail: 21. Date of Service: / / 22.
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Winegard Warranty Claim Application Instructions Upon completion of the repair of a Winegard product that is deemed a Winegard manufacturing error and is within the stated warranty period, complete the warranty claim application form. The completed form and the proof of purchase are to be both faxed or mailed to Winegard and attached to the defective product and returned to Winegard Company at the address listed on the bottom of the form.
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. 4. 5. 6. In the case of an OEM installed product, the retail date of purchase of that OEM product with the Winegard product listed on the invoice or the Factory installed options document. Must include the consumers name, address and telephone number. Must include the seller’s name address and telephone number. Must be legible at the time of receipt by Winegard Warranty Administration. Problem Information (This is the problem with the product). 35. Description of Problem….