PARTS MANUAL For MODEL 6000/6100 WIPLINE ... - Wipaire Inc.

Warranty Claim Form
Aircraft Owner Name: ___________________________________________________
Address:_____________________________________________________________
City, State, Zip:________________________________________________________
Phone: ____________________________
Fax: ____________________________
E-Mail Address:________________________________________________________
Aircraft Information
A/C Model :_________ A/C Registration ID:________A/C Serial Number:___________
Please circle the category that most describes the aircraft’s primary type of operations:
Commercial Operator Training/Rental Private Use Business
Use
Float / Ski Information
Float / Ski Model:_____________ Float / Ski Serial Numbers:_________ _________
Total Hours on Floats / Skis to Date: ________
Approximate Hours per Year of Use: _______________
Date Floats / Skis Went Into Service (New): ____________________________
Claim Information
Date of Claim:___________Faulty Part Nomenclature and Number:_______________
Company Performing Maintenance: _______________________________________
Work Order Number: ________________ Contact Person:_______________________
Phone: ____________________________
Fax: ____________________________
E-Mail Address: ________________________________________________________
Wipaire Representative and any RMA or Claim Numbers:
______________________
Please include a brief description of the conditions at the time of failure or damage, if
applicable, and any additional remarks:
___________________________________________________________________
Please fax or mail back to us. If you prefer, you can e-mail the form to
CustomerService@wipaire.com
1002177 10
Rev H