Compressors USA Inc

Distributor Name

Model Number
Street Address
City, State, and Zip S/N (Fab No.)
Phone Number Air End S/N
Contact Name
E-mail Address

Repair Start Date Voltage Readings

Repair Finish Date L1 - L2
L1 - L3
Customer Name L2 - L3
Street Address L1 - Ground
City, State, and Zip L2 - Ground
Phone Number L3 - Ground
Contact Name
E-Mail Address

Claim must be submitted within 30 days of

receiving repair parts.
LATE CLAIMS WILL BE DENIED

A Prior completed Failure Observations

Form is required for warranty processing.
Temperatures Pressure Readings Amp Readings
Ambient Load Pressure L1
Discharge Temp Unload Pressure L2
L3
Hours Loaded Hours Unloaded Total Hr 0
Description of the problem

Steps taken to restore the unit

 Warranty Claim Form
Parts Used
Factory
Supplied
QTY Part Number {QTY} Description Net Price Each Total
($ -  ) ($ -  )
($ -  ) ($ -  )
($ -  ) ($ -  )
($ -  ) ($ -  )
($ -  ) ($ -  )
($ -  ) ($ -  )
($ -  ) ($ -  )
($ -  ) ($ -  )
($ -  ) ($ -  )
($ -  ) ($ -  )
($ -  ) ($ -  )
($ -  ) ($ -  )
($ -  ) ($ -  )
($ -  ) ($ -  )

Parts Total ($ -  )

Labor
Travel Hours
On Site Hours
Total Labor Hours 0
Labor Rate ($ 85.00)
Labor Total ($ -  )

Mileage
Num. of Trips
Miles per Trip
Total Miles 0
Mileage Rate ($ 0.590)
Mileage Total ($ -  )

Claim Total
Servicing Technician

Customer Signature Cell or Phone

Please note any pertinent details of site conditions/ compressor condition or customer comments.
Parts Total ($ -  )
Labor Total ($ -  )
Mileage Total ($ -  )

Grand Total ($ -  )

Request further information &

documents from us at USA.
SERVICE@ELGI.com

Submit all documents over email to

USA.SERVICE@ELGI.com
0.00
Version 040622 A.K.B
further information &
ents from us at USA.
VICE@ELGI.com

documents over email to

ERVICE@ELGI.com

A.K.B