WARRANTY CLAIM FORM Dealer Info: Name:__________________________________________________________________ Contact Person:__________________________________________________________ Address:________________________________________________________________ _______________________________________________________________________ Phone:_________________________________________________________________ Customer Info: Name:__________________________________________________________________ Address:________________________________________________________________ _______________________________________________________________________ Phone:_________________________________________________________________ Product Info: Model #:_____________________ Number of Acres applied:_________ Serial #:____________________ Purchase Date:_______________ Invoice #:_______________________ Detail: (include all pertinent information as to nature of malfunction, defection, etc.) _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Warranty items to be repaired or replaced must be returned to and inspected by Valmar within 15 days of claim. Supply copy of Invoice. Quantity Part # Description Unit Price Ext. Amount _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Date:_______________ Dealer's Signature:__________________________________ This form must accompany all parts being returned otherwise claims cannot be processed.

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