UBC COOL CANADA Inc.

WARRANTY CLAIM FORM

ALL FIELDS MUST BE COMPLETELY FIILLED OUT
Authorization number is required before any repairs or returns can be made

Section A:

Service Company

Customer

Symptoms and summary of diagnosis made are required. List hours and explanation for each repair made. Give exact location of any leaks.

Section B:

Service performed

Hours

Parts replaced or refrigerant used (type and amount)

Price

∗ All replacement parts must be returned to UBC Group. Returned parts must include authorization number and serial number on box.

Labor Charges Summary