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