WARRANTY CLAIMS AND RETURN FORM
DATE	/      /						CLAIM #
MANUFACTURER					DEALER WORK ORDER #
DEALER							DATE PURCHASED		/       /
CONTACT							INVOICE #
ADDRESS							SERIAL #
CITY							MODEL #
STATE			ZIP
CUSTOMER NAME							DATE OF PURCHASE		/      /
ADDRESS							FAILURE DATE		/      /
							DATE OF REPAIR		/      /
HOURS OF OPERATION
MODEL OF TRACTOR							WARRANTY
TRACTOR HP							NEW
			PARTS USED TO MAKE REPAIRS
QUANTITY	PART #			DESCRIPTION				INV#	AMOUNT
								PARTS	0.00
								LABOR	0.00
HOURS OF LABOR			RATE					MILEAGE	0.00
MILEAGE								FREIGHT	0.00
								TOTAL	0.00
		DESCRIPTION OF REPAIRS OR REASON FOR RETURN
					SIGNATURE
BEAVER VALLEY SUPPLY INC					DATE RECEIVED AT BEAVER VALLEY				/       /
P O BOX 419					DELIVERY RECEIPT #
21366 HWY 36					RETURNED BY		IC    X
E-MAIL: dave@beavervalleysupply.com					DATE RETURNED TO MANUFACTURER				/        /
ATWOOD KS 67730					DELIVERY RECEIPT #------RGA #
PH    800-982-1280					RETURNED BY
FAX  800-536-6263					CREDIT INVOICE #