フォーム

Rosemount Claim Form

  1. Customer Information
  2. Product Information

Customer Information

Please avoid using special characters as they will cause the form to error.

Customer Name null
Customer Number
City
State
Country
Submitter Name null
Email null
Phone
Claim Number Non-Collins Claim ID null
Purchase Order/Repair Order null
Contract Applied Contract Name: PSAA, SSC..... null
Letter of Delegation on File
Letter of Delegation on File
Removal: A/C Type null
Removal: A/C Serial #
Removal: A/C Tail # null
Original Fit: A/C Type or Spares PO null
Original Fit: Serial #
Original Fit: Tail # Type N/A if Spares PO null
Manufacturer's Part # One Collins Part Number per claim null
Old/Removed Serial # One Collins Part Number per claim null
New/Installed Serial # One Collins Part Number per claim null
Labor Hours
Labor Rate
Freight
Parts: Part Number Hit ENTER to add more than one part.
Parts: Quantity Hit ENTER to add more than one part.
Parts: Price per Unit Hit ENTER to add more than one part.
Parts: Total Amount Hit ENTER to add more than one part.
日
月
火
水
木
金
土
Date of Failure null
日
月
火
水
木
金
土
Date of Repair
Complaint Please avoid using special characters as they will cause the form to error.
Corrective Action Please avoid using special characters as they will cause the form to error.
Notes Please avoid using special characters as they will cause the form to error.

Contact Us

Commercial Transport & Business Aviation Warranty Support

PH: 319-295-5000

Phone Tree Menu

Email Avionics Warranty

 

Rosemount Warranty Support

Email Rosemount Warranty

 

Kidde Warranty Support

Email Kidde Warranty

Template Language

Note: Templates are best used when submitting batch claims of registration\retrofits that involved multiple equipment types.