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Cozy Warranty Form
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Warranty Claim Form
Distributor/Dealer Washer Specialties
Claim Date *
Owner Name *
Unit Address *
Apartment No.
Phone (with area code) *
City *
State *
Zip Code *
Servicing Dealer
City
State
Zip Code
Phone (with area code)
Brand *
Unit Model No. *
Unit Serial No. *
Start-Up Date *
Date Failed *
1 ) PART NUMBER
Failed
Replacement
QUANTITY
DESCRIPTION
REASON FOR FAILURE
2 ) PART NUMBER
Failed
Replacement
QUANTITY
DESCRIPTION
REASON FOR FAILURE
3 ) PART NUMBER
Failed.
Replacement.
QUANTITY.
DESCRIPTION.
REASON FOR FAILURE.
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Phone: 316 263-8179 or 800 835-1010, Fax: 316 263-2040 or 800 835-1150
224 Indiana,    Wichita,  Ks   67214
8:00 AM to 5:30 PM M-F,  8:00-Noon on Saturday,  Closed on Sundays and Holidays.
Tempstar Distributor for Kansas

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