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