WARRANTY CLAIM FORM

Please complete the form carefully.  Once submitted, it cannot be changed.

Owner Name *
Owner Name
Owner Phone Number
Owner Phone Number
Dealer Phone Number
Dealer Phone Number
Name of Person Submitting Claim:
Name of Person Submitting Claim:
Date of Submission:
Date of Submission:
Date of Purchase *
Date of Purchase
Date of Occurrence:
Date of Occurrence:
Please provide as much detail of the issue as possible.
$
List part numbers and quantities used.
Please submit a copy of the Dealer Work Order to jacob@harvest-international.com
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