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

Warranty Request Form

Information Needed:

Claim No*: Date Of Failure*: Date of Repair*:

Dealer Name*: Phone No*:


Customer Name*: Phone No*:


Numbers of Photos Attached*:

Model*: Serial No*: Date of Delivery*:

Truck Hours*: Mixer*: High Mixer*: Low

Reason For Request*:

Qty:Part No:Description:Invoice No: Cost:



Report on work done to repair Failure:

Signed by Dealer: Date:

Signed by Laird MFG: Date:

Date Emailed or Faxed: Attn:

Attach up to 4 photos of repairs:

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: