MasPower Industrial Application Warranty Claim Form
(Engine & Power Equipment)

* denotes required field

Date Received:
*Dealer Number:
Dist. Claim Number:
Distributor Name:
*Dealer or OEM Name:
*Dealer or OEM Phone Number:
*Dealer Address:
*City
*State
*Zip
*Dealer E-Mail Address:
*Customer Name:
*Customer Phone Number:
*Customer Address:
*City
*State
*Zip

 Claim Data
 
*Engine Model:
*Serial Number:
*Delivery Date:
*Machine Model:
*Serial Number:
*Date of Failure:
Generator Model:
Serial Number:
*Repair Date:
*Hours of Use:
Mech. Name:
*Spec. of Equipment
 *Rental Use?

 Explanation of Failure
 
*Complaint:
*Cause:
*Correction:
Work Hour(s) Breakdown:
*You must include information in the following fields to generate the total repair time.
Diagnosis:
Repair:
Break In/Sea-trial:
Cleaning:
Any Additional Time Required:
Reason For Additional Time:
*Total Repair Time:
*Failure Code

 Part Used
 
QTY Part No. Part Name Part Price
Add Additional Parts

 Warranty Labor
 
Working Hours
H x 		Rate
 Total
=
Travel Hours
H x 		Rate
 Total
=
Mileage Distance
km
mile
Rate

x = 		Total

Others

Total Parts
Total Labor
Dealer Notes

Attach Photos (if available)

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