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Claim Type

First Name

Last Name

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Dealer Information

Dealer Name

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Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Product Information

Manufacturer

Model Number

Serial Number

Order Number

Installation Date

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Part Information

Re-order	Part Number	Quantity	Part Description	Description of Problem	Weight	Operations
	Part Number	Quantity	Part Description	Description of Problem	Item weight

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15 MB limit.
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Upon approval, ship parts to:

Delivery Information

Freight Company

Pro Number/Tracking Number

Delivery Date

Missing Merchandise

Part Number

Part Number
	Part Number	Item weight

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Damaged Merchandise?

Damaged Merchandise Information

Re-order	Part Number	Damage Type	Weight	Operations
	Part Number	Damage Type Visible Concealed	Item weight

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Was Shipment Refused?

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15 MB limit.
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Dealer Information

Dealer Name

Dealer Account Number

Order Information

Purchase Order Number

Original AF Sales Order Number

Sale Date To Consumer

Reason for return

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15 MB limit.
Allowed types: gif, jpg, png, jpeg.

Are you returning all items on order?

List the item(s) being returned

List the item(s) being returned
	List the item(s) being returned	Item weight

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Is product in original packaging?

Will the customer need a return label? Use customer info provided above.

Is product on a pallet?

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