Berg Chilling Systems Inc.  Warranty Claim Form

Fax to: Berg Service Dept.

416 - 755 - 6022

 Claim #: Date: ( mm / dd / yy )
Claim Submitted
 Job

By:

 Name:   

Address:

Company:

Address:

Phone #:
Fax #:
Berg Model #:

Voltage:

Serial #:
Details of Failure



Describe the nature of the failure.

Part Number(s)
( if applicable)

Quantity

Cost for Repairs

Date of Failure

  ( mm / dd/ yy )

 Date of Original Start-Up

( mm / dd/ yy )

Total:

Requesting:

Repair

Replace

Reimburment

Other

To Qualify for Limited Labour Warranty,
you must include a sign service report and
a copy of the contractor's invoice.
Attached:          Yes:               No:
______________________________________________________________________________________________________________________
Do not write below this line.
Date Form ( mm / dd / yy )
Received:
Warranty Claim Form Being
Handled By: 
______________________________________________________________________________________________________________________
Note:     All defective parts must be returned prepaid and within 15 days of the failure date.
No credit will be issued if the defective parts are not returned prepaid and within the specified time allowed.