JM Supply - Warranty Claim Form

Our Poteau location is now open!

Please see JM Supply Terms & Conditions before filling out.

Warranty Claim Form must be completed before credit will be issued.

Date:

Dealer Name: *

Address: *

City: *

State: *

Zip Code: *

Phone #: *

HOME OWNER'S INFORMATION

Owner's Name: *

Address: *

City: *

State: *

Zip Code:

Phone:

Please indicate the type of claim (choose only one): Original Equipment Warranty Replacement Part Warranty

FAILED PART INFORMATION

Unit Install Date: *

Part Failed Date: *

Part Replacement Date:

Unit Model #: *

Unit Serial #: *

Failed Part #: *

Failed Part Serial # (compressors only):

New Part #: *

New Part Serial # (compressors only):

Part Description:

Failed Part #:

Failed Part Serial #:

New Part #:

New Part Serial #:

Part Description:

Failed Part #:

Failed Part Serial #:

New Part #:

New Part Serial #:

Part Description:

Failed Part #:

Failed Part Serial #:

New Part #:

New Part Serial #:

Part Description:

Equipment Location: Attic Closet Outdoor

Technical Reason Part Failed: *

Original Purchase Invoice:

Replacement Pick Ticket / Invoice #: *

Please return with defective parts to our Warranty Dept. All fields marked * are required.

DEALER INFORMATION

HOME OWNER'S INFORMATION

FAILED PART INFORMATION