Defective Product Claim Form

January 14, 2019

PERSONAL INFORMATION DEALER INFORMATION

First Name Jesse Dealer Name Carrier

Last Name Thorne Franchise W/G Totaline

Address 119 Magill Ave Address 945 Cambrian Heights Dr.

City, PROV Postal Code Lively On P3Y1K6 City, PROV Postal Code Sudbury On P3C5M6

Email jthorne@psltd.ca Email

Phone Number 705-665-6731 Phone Number 705-566-3174

Date product was purchased: dd/mm/yyyy

Product Information & Complaint

Product Name Midbec Product Model 4100139 Compressor

Order Date Oct 17th 2018 Delivery Date Oct 30th 2018

Warranty Address

Description of Failure: The compressor was brand new took out of box & installed it in a PTAC unit for a hotel room, once installed &

Properly evacuated I recharged the unit with proper amount of refrigerant & tried to start it. After plugged in it would not start checked

Voltage going to compressor & found it was correct but compress. Would not start. About the 3 rd try it started blowing the reset on the
power cord. Ohm out compressor and it was fine but just will not start.

Present this form, pictures, and a copy of your receipt to your authorized local dealer.
The authorized dealer will then submit all the documentation for a review.
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Customer Signature Date For [ Date