Paladin Light Claim Form | Paladin Attachments

Dealer Name *

Attn *

Address *

City *

State *

Zip *

Phone *

Fax *

Email *

Serial # *

HRS (on attachment) *

RMA# *

Attachment Description *

Repair Date *

Month

Day

Year

Machine Make/Model *

Failure Date *

Month

Day

Year

Application *

Details of Failure *

Corrective Action *

Total Labor Hours *

Total Labor Costs *

Freight *

Dealer Invoice No *

Misc. Costs - i.e. outside costs *

Submit Service Invoice along with Supporting Documentation

Qty

Part #

Description

Cost

Total Parts Cost *

Total Claim Cost *

Attachments

Files must be less than 64 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx ppt pptx gz tar zip.

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