General Warranty Form
PRAIRIE SUPPLY
3232 BOULDER AVE. FORT WAYNE, IN 46802 (260) 436-1551
CONTRACTOR NAME
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PHONE NUMBER
Format: (000) 000-0000.
CUSTOMER NAME
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PHONE NUMBER
Format: (000) 000-0000.
CONTRACTOR SERVICER #
PRODUCT INFORMATION
MODEL
SERIAL
DATE OF INSTALL
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
DATE OF FAILURE
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
PART
REASON FOR FAILURE
PART
REASON FOR FAILURE
PART
REASON FOR FAILURE
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