BEAVER VALLEY SUPPLY CO, INC.
		WARRANTY CLAIMS AND RETURN FORM
DATE	/      /						CLAIM #
MANUFACTURER
DEALER
ADDRESS							INVOICE #
CITY							SERIAL #
STATE			ZIP				MODEL #
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
								LABOR
HOURS OF LABOR			RATE					MILEAGE
MILEAGE								FREIGHT
								TOTAL
		DESCRIPTION OF REPAIRS OR REASON FOR RETURN
					SIGNATURE
BEAVER VALLEY SUPPLY INC					DATE RECEIVED AT BEAVER VALLEY				/      /
P O BOX 419					DELIVERY RECEIPT #
EAST HWY 36					RETURNED BY		IC    X
ATWOOD KS 67730					DATE RETURNED TO MANUFACTURER				/      /
PH    800-982-1280					DELIVERY RECEIPT #------RGA #
FAX  800-536-6263					RETURNED BY
					CREDIT INVOICE #