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MRA Submission Form

Date Submitted: Distributor:
Contact Fax Number: Contact Name:
Equipment Model: Email:
Original Date of Sale: Serial Number:
Date of Claim: Hours on meter:
Customer Name: Customer Invoice #:
  PART # QTY DESCRIPTION SERIAL # or NA REASON FOR RETURN
1
2
3
4
5
6
7 Labour 90 Day Labour @ $50.00/hr
Remarks for the team regarding this MRA



OFFICE USE ONLY
M.R.A. Number: ___________

Date Received:    Received by:
Location of Material:    Examination Report:
Warranty: Yes No    Issue Credit: Yes No
Item: #1 #2 #3 #4 #5 #6 #7
Date:    Invoice Number:
Repair and Return
Date:    Invoice Number:
Item: #1 #2 #3 #4 #5 #6 #7
Warranty Denial Notification
Date:    
Item: #1 #2 #3 #4 #5 #6 #7
90 Day Labour Credit Yes No    Approved Hours @ $50.00
Warranty Inventory: Yes No $50 Deductable Charge
 
Original Vendor RMA# for return:
 
Name:    Company Name:
Account #:    Date of purchase:

Esteam Remarks:

Contact Us


Lou Querin - Sales Manager
Email: lquerin@cleanco.com
Phone: 1-800-653-8338 x 2450


Miranda Himmelman - Sales/Marketing
Email: miranda@cleanco.com
Phone: 1-800-653-8338 x 2452


Chris Hill - Sales/Service
Email: chill@esteam.com
Phone: 1-800-653-8338 x 2445


Toll Free: 1-800-653-8338
Local: (403) 291-7050
Fax: (403) 291-0546

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