AMI WARRANTY CLAIM - CANADA - AMI Attachments®

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Dealer Name*

Date*

Address*

Address City/Province/State Postal/Zip Code

Phone Number*

Dealer Claim #*

AMI Serial #*

Date of failure*

Completed By

Nature of Failure (Pictures required)*

ATTACH PICTURES (Max. File Size: 8 MB)*

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INVOICE#	QTY	PART#	DESCRIPTION	UNIT PRICE	TOTAL	ACTION

Service Labour - $160 CAD/hour (Enter Number of hours):

Total Labour Cost:

Net Claim:

RGA # (If Applicable)

Bill of Lading #: (If applicable)

Unique ID