Formulier

Business and Regional Claim Form

Preferred method for submitting BULK claims is to use the claims template on the main warranty page.

  1. Customer Information
  2. Product Information

Customer Information

Please avoid using special characters as the will cause the form to error. (", ', :)

Dealer Name/OEM Name Vereist
Dealer Number/Customer Number Vereist
City Vereist
State
Country Vereist
Submitter Name Vereist
Email Vereist
Phone
Reference Claim Number (Non Collins ID) Vereist
Work Order / Invoice Reference
CASP Contract #
Customer Name
City
State
Country
A/C Type Vereist
A/C Serial Vereist
A/C Tail
Manufacturer's Part # One Collins Part Number per claim Vereist
Old/Removed Serial # One Equipment Serial Number per claim Vereist
New/Installed Serial # One Equipment Serial Number per claim Vereist
Labor Hours Vereist
Labor Rate Vereist
Freight (CASP Only)
Date of Failure Vereist
Date of Repair Vereist
Complaint Please avoid using special characters as they will cause the form to error.
Corrective Action / Parts Used 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.

Templates for Batch Claims/Registrations

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