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Dealer Information:
GNE Account Number: i.e. JON001
Company Name: enter your company name if applicable
Primary Claim Contact: person entering information
Address: enter your address
City: enter your city
State: enter your state
Zip: enter your zip code
Telephone: enter your phone number
Email: enter your email address
Customer Reference Number: enter your job reference number
Customer Information:
Company Name: enter your customer's information (if applicable)
Primary Contact: enter your customer's first and last name
Address: enter your customer's address
City: enter your customer's city
State: enter your customer's state
Zip: enter your customer's zip code
Telephone: enter your customer's phone number
Email: enter your customer's email address
Equipment Information:
Dosko Model Number: enter the units model number(i.e. BHVH2213GX)
Dosko Serial Number: enter the units serial number(i.e. BHVH2213GXAXXXXXXXX)
Warranty Details:
Original Purchase Date: enter date of sale on sales receipt
Failure Date: enter date the unit failed
Repair Date: enter the date you repaired the unit
Hours of Use: enter hours machine has been used
Description of Problem & Detail of Repair: Please give a complete description of problem, part in which caused the problem and detail(s) of repair
Subtotals and Additional Charges:
Other Charges: please give details on other charges if applicable
Posted Shop Labor Rate: enter your hourly posted shop labor rate
Hours Worked: enter hours worked on repair