Warranty Claim Form • FireFly Automatix

FireFly Automatix Warranty Claim

"*" indicates required fields

FireFly Support Portal Ticket Number*

Claim Date*

Name (Point of Contact for this Warranty)*

First Last

Phone*

Email address*

Enter Email Confirm Email

Company or farm name*

Physical address of machine*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Machine Model*

Machine Serial Number*

Machine Hours*

Warranty Invoice Number

Failure Date*

Photo(s) of Failed Parts

Max. file size: 128 MB.

Description of Failure*

Corrective Action Taken*

Additional Notes/Questions

Signature

I hereby certify that the information provided is true and correct to the best of my knowledge. (Enter name below to sign)

This field is for validation purposes and should be left unchanged.