AMI WARRANTY CLAIM - USA - AMI Attachments®

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If the form cannot be filled out or submitted, please contact warranty@amiattachments.com.

Dealer Name*

Date*

Address*

Address City/Province/State Postal/Zip Code

Phone Number*

Email*

Dealer Claim #*

Date of failure*

AMI Serial #*

In Service Date*

Completed By

Nature of Failure (Pictures required)*

ATTACH PICTURES (Max. File Size: 10 MB)*

Please attach picture(s) supporting your claim

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INVOICE#	QTY	PART#	DESCRIPTION	UNIT PRICE	TOTAL	ACTION

Service Labour - $125 USD/hour (Enter Number of hours):

Total Labour Cost:

Net Claim:

RGA # (If Applicable)

Bill of Lading #: (If applicable)

Unique ID