Warranty # Warranty Claim / Assessment Report Submitted By: Contractor: SU#/RU#/Job Number Ship To: Customer P.O. When After start-up After months During warranty period Happened Repeatedly) Other ( Suddenly ▪ Second Time ▪ Any particular ( ) System Screw Recip Compo & Unit Piping Motor Starter Control ▪ ▪ ▪ ▪ On What Others ( ) Date Mfg Date Model / Type Reported Claim & Non-Conformity Report Attachment: Y N ▪ * Describe as it was reported. Attachment: Y N ▪ * Symptom & cause to be in items and at least two layer deep. Symptom Cause Below to be completed by Warranty Administrator Material Process Attachment: Y N Date ▪ * How claims processed & reported Required parts and part number if known: By: Confirm with: Cost Customer: Charge No Charge Discuss Inter Mycom: charge No Charge ▪ ▪ ▪ Corrective Instruction Y N (detail) Attached File: □ ▪ □ Date By Confirmed by Warranty Accepted Warranty Declined MGR Initiate Remarks: / / final Action taken date / All initiated member: Please email report to : / warranty@mayekawausa.com Processed By: Note: Labor charges for repairs and freight charges for new part(s) and returned part(s) are not covered under warranty. Customer PO is required for all labor (includes: travel and expense) and freight charges for returned and new parts.
Warranty Claim / Assessment Report Warranty # Submitted By: Contractor: SU#/RU#/Job Number Ship To: Customer P.O. When Happened System After start-up After months During warranty period Other ( Suddenly ▪ Second Time ▪ Repeatedly) Any particular ( ) On What Screw ▪ Recip ▪ Compo & Unit ▪ Piping ▪ Motor Starter Control Others ( ) Date Reported Model / Type Mfg Date Claim & Non-Conformity Report Attachment: Y ▪ N * Describe as it was reported. Attachment: Y ▪ N * Symptom & cause to be in items and at least two layer deep. Symptom Cause Below to be completed by Warranty Administrator Material Process Attachment: Y ▪ N * How claims processed & reported Date By: Confirm with: Required parts and part number if known: Cost Customer: Charge ▪ No Charge ▪ Discuss Inter Mycom: charge ▪ No Charge Corrective Instruction (detail) Attached File: □ Y ▪ □ N Date By Confirmed by final Warranty Accepted Warranty Declined Remarks: MGR Initiate / / Action taken date / All initiated member: Please email report to : warranty@mayekawausa.com / Processed By: Note: Labor charges for repairs and freight charges for new part(s) and returned part(s) are not covered under warranty. Customer PO is required for all labor (includes: travel and expense) and freight charges for returned and new parts.
Warranty_claim_form.docx