Mi-T-M Corporation

Warranty Claim Form

For Mi-T-M Dealer and Service Center Use Only

We can only process one claim per form. Please submit separate forms for each warranty claim you have.

* Indicates Required Fields

Dealer Information

Dealer Name: *

Store No.:

Account No.:

Work Order No.:

Dealer Email: *

Dealer Phone: *

Product Information

Model No.: *

Serial No.: *

Mi-T-M Order No.:

Date of Sale:

Product Category:

Customer Information

Customer Name:

Customer Phone:

Repair Date:

Issue Information

Customer Contention: *

Corrective Action:

Part Entry - 11 Max

No parts entered. Fill out each part you wish to add to the warranty claim in the form below and click "Add to Parts List", you will then see it appended to the parts list.

Part No. *

Qty *

Dealer Net *
$

Description *

Labor Operations No.

Flat Rate Time

Mi-T-M Flat Rate Manual

Labor Information

Freight:

Shop Labor Rate (per hour):$

Repair Information

Date of Claim:*

Service Manager Name: *

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Warranty Claim Form