AMI WARRANTY CLAIM - CANADA - AMI Attachments®

"*" indicates required fields

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: 10 MB)*

Please attach picture(s) supporting your claim

Drop files here or

Max. file size: 10 MB.

Invoice Table for CANADA Warranty Claim form

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)