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Cozy Warranty Form
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Warranty Claim Form
Distributor/Dealer Washer Specialties
 
Claim Date *
 
Owner Name *
 
Unit Address *
Apartment No.
 
Phone (with area code) *
 
City *
 
State *
 
Zip Code *
Servicing Dealer
City
State
Zip Code
Phone (with area code)
 
Brand *
 
Unit Model No. *
 
Unit Serial No. *
 
Start-Up Date *
 
Date Failed *
1 ) PART NUMBER
Failed
Replacement
QUANTITY
DESCRIPTION
REASON FOR FAILURE
2 ) PART NUMBER
Failed
Replacement
QUANTITY
DESCRIPTION
REASON FOR FAILURE
3 ) PART NUMBER
Failed.
Replacement.
QUANTITY.
DESCRIPTION.
REASON FOR FAILURE.
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