Product Warranty
Reclaim Fee Maximum $25.00 Allowed (for 290R) _______________________________________ $________________
PART Part Description and/or Part Number(s) Used __________________________________________ $________________
REIMBURSEMENT (Please list separately below) ______________________________________________ $________________
Replacement compressor serial number ______________________________________________ $________________
Miscellaneous charges (please explain) _______________________________________________ $________________
Tax (if applicable)_________% $________________
Grand Total $________________
Signature Required (or attach Service Agents orginal invoice with signatures.)
CUSTOMER SIGNATURE___________________________________ SERVICE TECHNICIAN SIGNATURE_______________________________
(Technician making refrigeration system repairs must be certified per EPA requirements)
Date Signed______________________________________________ Date Signed___________________________________________________
*IF NON-OEM PARTS ARE USED WITHOUT PRIOR APPROVAL THIS MAY EFFECT FUTURE WARRANTY CLAIMS