Furnace/AC Model No.
Serial No.
Thermo Product Part No.
Part Description
Date Defective Part Removed/Replaced (mm/dd/yyyy)
Original Installation Date of Furnace/AC (mm/dd/yyyy)
Reason for Warranty Claim
Servicing Contractor
Contractor Street Address
Contractor City
Contractor State
Contractor Zip
Contractor Phone Number (include area code)
Contractor Contact Name
Contractor Email (for electronic reply)
Homeowner/Job Name
Homeowner/Job Address
Homeowner/Job City
Homeowner/Job State
Homeowner/Job Zip
5 + 14 =
