1130 Stuart Drive, Merced, CA 95341
P: (209) 722-4145 F: (209) 349-8934
www.lairdmfg.com

Warranty Consideration Questionnaire Form

Claim#: RGA#:

Questionnaire:

Customer Name: Dealer:

Machine Serial No: Machine Sale Date:

Gearbox/Motor Serial No:: Part No:

Date Gearbox/Motor Put In Use: Hours In Use: Failure Date*:

Provide Invoice No. purchased or specify if unit was original equipment:

Description of Complaint:

Gearbox/Motor disassembled? If so, provide report:

Regular maintenance/inspections preformed:

Oil leaking:

Oil black/Current oil level:

Noise? Grinding, squeal, clack:

Heat:

Load empty/load full:

Shifting problems:

Shafts spin freely/seized:

Additional Comments:

Signed by Dealer: Print: Date Signed:

If you would prefer to download a copy of the form click HERE. Fill out form with adobe acrobat and save file.
Upload Completed form:

Contact Information

Email:
web@lairdmanufacturing.com

Phone:
Corporate Office:
(209) 722-4145
Sales, Parts & Service Merced:
(209) 722-4146
Sales, Parts & Service Tulare:
(559) 686-9303

Office Address:

Merced Corporate Office / Production Plant:
1130 Stuart Dr.
Merced, California 95341

Sales, Parts, & Service:
Merced
531 South Highway 59
Merced, California 95341

Sales, Parts & Service:
Tulare
900 N. J Street
Tulare, CA 93274

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Warranty Consideration Questionnaire Form

Warranty Consideration Questionnaire Form

Claim#: RGA#:

Questionnaire:

Customer Name: Dealer:

Machine Serial No: Machine Sale Date:

Gearbox/Motor Serial No:: Part No:

Date Gearbox/Motor Put In Use: Hours In Use: Failure Date*:

Provide Invoice No. purchased or specify if unit was original equipment:

Description of Complaint:

Gearbox/Motor disassembled? If so, provide report:

Regular maintenance/inspections preformed:

Oil leaking:

Oil black/Current oil level:

Noise? Grinding, squeal, clack:

Heat:

Load empty/load full:

Shifting problems:

Shafts spin freely/seized:

Additional Comments:

Signed by Dealer: Print: Date Signed:

If you would prefer to download a copy of the form click HERE. Fill out form with adobe acrobat and save file.
Upload Completed form:

Have a Question?

Drop us a line today!

Contact Information

Warranty Consideration Questionnaire Form

Warranty Consideration Questionnaire Form

Claim#: RGA#:

Questionnaire:

Customer Name*: Dealer*:

Machine Serial No*: Machine Sale Date*:

Gearbox/Motor Serial No:*: Part No*:

Date Gearbox/Motor Put In Use*: Hours In Use*: Failure Date*:

Provide Invoice No. purchased or specify if unit was original equipment:

Description of Complaint:

Gearbox/Motor disassembled? If so, provide report:

Regular maintenance/inspections preformed:

Oil leaking:

Oil black/Current oil level:

Noise? Grinding, squeal, clack:

Heat:

Load empty/load full:

Shifting problems:

Shafts spin freely/seized:

Additional Comments:

Signed by Dealer: Print: Date Signed:

If you would prefer to download a copy of the form click HERE. Fill out form with adobe acrobat and save file. Upload Completed form:

Have a Question?

Drop us a line today!

Contact Information

Customer Name: Dealer:

Machine Serial No: Machine Sale Date:

Gearbox/Motor Serial No:: Part No:

Date Gearbox/Motor Put In Use: Hours In Use: Failure Date*:

If you would prefer to download a copy of the form click HERE. Fill out form with adobe acrobat and save file.
Upload Completed form: