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Contractor Information

Homeowner Information

Job Info

Nature of problem (Include diagnosis and date of diagnosis)

Type of service performed and details of repair

List of part numbers used (even if still under manufacturer's warranty)

Additional Provisions:
1. Loose nuts, bolts, wires, and insulation are not covered.
2. Noise, vibrations, and adjustments are not covered.
3. Fuses external to the equipment are not covered.
4. Only one trip per service call will be reimbursed. Times include refrigerant evacuation/recharge. Assembly is
defined as all components making up the whole of a part.
5. Thermostats purchased with covered equipment included.
6. Trip/Diagnostic Charge - $50.00 - paid once per service issue.
7. Installing Contractor covers first year labor; Extended Labor Warranty begins one (1) year from Installation Date.
8. Labor Rate is $100.00 per hour.
9. Contractor must ensure that Purchaser has registered Equipment for Ten (10) year part warranty.
10. Time allowances marked with an * already include refrigerant handling.

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January 22, 2021 2:07 pm EDT

Claim Submission Uploaded by Dustin Smith - admin@midwestwarranties.com IP 69.61.204.250