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Warranty Form
 
ANTHONY LIFTGATES, INC.
 
WARRANTY CLAIM FORM
 
CLAIM# LIFTGATE MODEL: SERIAL No:
       
CLAIMANT:    
YOUR NAME: PHONE NO:
YOUR E-MAIL ADDRESS:    
ADDRESS:    
CITY: STATE:
ZIP:    
       
END USER:    
END USER CITY:    
END USER STATE:    
 
DESCRIBE LIFT GATE PROBLEM:
 
DESCRIBE REPAIR PROCEDURE:
 
PARTS USED
 
  QUANTITY PART NO. DESCRIPTION PRICE EACH EXTENDED PRICE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
LABOR HOURS:
FLAT RATE LABOR: $
EXT:
        TOTAL:
THIS REPAIR WAS PERFORMED BY:
RGA# for REPAIRED PARTS:
 
 
 
 
 
 

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