Warranty Claim Number

Mailing: Shipping: P.O. Box 1160 2009 Roseport Rd. Warranty Claim Number St. Joseph, MO Elwood, KS 64502-1160 66024 ph: 800-255-0317 fax: 785-989-3075 Date: ______

Dealer: ______Customer: ______Address: ______Address: ______City, State, Zip: ______City, State, Zip: ______

Model: ______Serial Number: ______Customer Delivery Date: ______

(A) Description of Failure Failure Date: ______Hour Meter Reading: ______(B) Corrective Action Taken Repair Date: ______

Problem Part Number: ______Problem Part (mfg.) Serial Number: ______Call for Returned Goods Authorization (RGA) number: ______

Quantity Part Number Description Unit Cost Total Cost Snorkel Invoice Number

Dealer Authorized Signature: ______Certify that the information contained hereon is accurate. Unless otherwise shown, services described were performed at no charge to owner. Records to support the validity of this claim are available for inspection by representatives of Snorkel.

Important Note: Attach a copy of work order for repair to this claim when submitting to the Snorkel Warranty Department. Credit will be issued only following inspection and disposition by factory of defective parts returned prepaid within 45 days from date of failure. Returned parts must be accompanied by packing list copy of this claim form. Also, all claims must be filed within 15 days of machine failure date. Please refer to claim number on all attachments and communications.

Dealer Labor Expenses Travel Time Do not write in the section below, for internal use only. Date Labor (hrs) Date Hrs Dealer Code: ______Problem Code: ______Bulletin #: ______Parts $______Total Hours ______@ $ ______per hour* * Dealer authorized field repair rate Labor $______hrs @ $_____ an hour Travel $______hrs @ $_____ an hour  Rejected Misc. $______By: ______Date: ______Freight $______Total Product Account Number: ______Credit $ ______

Fax or mail one copy to Snorkel International Inc. Enclose one copy with returned goods WCF Rev. 3/24/03