Claim Form

Fill-in the form and transmit it to us by clicking "send." We will respond to your claim request promptly. Entries marked with a red * are required.

Claim General Information

Request code:

Claim date:

Magnum Dealer Information

Magnum customer ID:

Company:*

Street address:*

City:*

State / Province:*

Country:

Zip / Postal Code:*

Phone:*

Fax:

Warranty contact:*

Email:*

Dealer reference #:

End User Information

Customer Name:

Street address:

City:

State / Province:

Country:

Zip / Postal Code:

Phone:

Product Information

Unit model number:*

Unit serial number:*

In service date:*

Failure date:*

Unit hours:*

List complaint, cause & correction in detail with technical data for claim consideration:*

Failed Part Details

*** The amount paid for a part purchased at an outside vendor will be reimbursed at Magnum Products, LLC's discretion. ***

Part1

Quantity:

Part #:

Part Description:

SO # or Invoice #:

Price (U.S. $):

Labor hrs. (rate $60/hr):

Part2

Quantity:

Part #:

Part Description:

SO # or Invoice #:

Price (U.S. $):

Labor hrs. (rate $60/hr):

Part3

Quantity:

Part #:

Part Description:

SO # or Invoice #:

Price (U.S. $):

Labor hrs. (rate $60/hr):

For Magnum Use Only

Claim approved:

Yes No

Approved by:

Claim approval date:

Parts return:

Return to Magnum Scrap at customer

Date parts returned:

RGA number:

Notes:

Account #:

Amount:

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