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Warranty Parts and Labor Claim Form

Better machines, better ice (and slush!)

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Icetro America Parts and Labor Warranty Claim Form

Date of Failure*

MM slash DD slash YYYY

Date Repaired*

MM slash DD slash YYYY

Install Date

MM slash DD slash YYYY

Model No.*

Serial Number*

Service Agent Information

Company Name*

Address*

Unit No. / Suite No.

City*

State*

ZIP*

Phone*

Email (NOTE TO DISTRIBUTORS: if this claim is filed by a distributor, put the distributor email in this field)*

Service Agent Information - Check here if

Check here if you sold this equipment

Check here if you lease this equipment to the customer

Distributor Information

Company Name

City

State

Email (Distributor)

Distributor Information - Check here if

Check here if you sold this equipment

Check here if you lease this equipment to the customer

Customer Information

Company Name*

Contact Name*

Address*

Unit No. / Suite No.

City*

State*

ZIP*

Phone*

Email

If claiming parts only, click this box.

If claiming parts only, click this box.

LABOR Performed:

Description of work performed: provide symptoms, diagnosis, and resolution; provide explanation; give location of any leaks*

Hours*

Please enter a number greater than or equal to 1.

Labor Rate ($100 is standard)*

Please enter a number greater than or equal to 0.

Subtotal Labor ($)*

Please enter a number greater than or equal to 0.

Reported Complaint

Total Labor $

Please enter a number greater than or equal to 0.

Click here if you USED parts for this claim

Click here if you USED parts for this claim

PARTS Replaced: all parts are to be obtained from Icetro America, Inc., and retained for 30 days

Part No.*

Part Name/Description*

Cost ($)*

Please enter a number greater than or equal to 0.

Qty.*

Please enter a number greater than or equal to 1.

Subtotal Parts ($)*

Please enter a number greater than or equal to 0.

*If parts were received at zero value from Icetro America or an Icetro Distributor, enter "$0" for cost.

If parts were purchased, please enter the price you paid and attach invoice here:

Total Parts $*

Please enter a number greater than or equal to 0.

Refrigerant

Did you use refrigerant?

Did you use refrigerant?

Type used

Amount used (oz.)

$1.75 per oz. ($28/lb.)

Please enter a number from 1 to 1.75.

Total Refrigerant ($)

Do you have miscellaneous costs for repairs that required opening the refrigeration system (including brazing supplies, vacuum pump, recovery equipment, etc)?

Do you have miscellaneous costs for repairs that required opening the refrigeration system (including brazing supplies, vacuum pump, recovery equipment, etc)?

Miscellaneous material up to $75.00 for repairs requiring opening of refrigeration system (includes brazing supplies, vacuum pump, recover equipment, etc.) Only fill in if necessary ($)

Sub-Total*

Tax %

Tax ($)

Claim Total*

Additional Notes or Comments

Invoice Number*

Attach copy of invoice here:*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.

Service Technician Name*

Date of Submission*

MM slash DD slash YYYY

Do you have photos that were requested by Icetro or that could help clarify the issue?

Do you have photos that were requested by Icetro or that could help clarify the issue?

If photos were requested by Icetro or will help clarify the issue, please attach here:

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB, Max. files: 10.

Only provide photos if necessary

This form will be submitted to Icetro America.
For follow up, please email tech.support@icetroamerica.com.

This field is hidden when viewing the form

Icetro Claim Number

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Select W9 File

Accepted file types: pdf, Max. file size: 20 MB.

If you have never submitted a W9 to Icetro America for warranty claim payment, please do so here.

"*" indicates required fields

Icetro America Parts and Labor Warranty Claim Form

Date of Failure*

MM slash DD slash YYYY

Date Repaired*

MM slash DD slash YYYY

Model No.*

Serial Number*

Distributor Information

Distributor Name*

City*

State*

Email (Distributor)*

Service Agent Information

Service Agent Name*

City*

State*

Customer Information

Customer Name*

City*

State*

Reported Complaint*

Total Hours

Brief Description of Labor Performed*

Part Nos. Used

Purchased By

Service Company

Provided to them at no charge

No Part Used (only labor)

Refrigerant

Refrigerant Used?

Yes

No

Do you have miscellaneous costs for repairs that required opening the refrigeration system (including brazing supplies, vacuum pump, recovery equipment, etc)?

Do you have miscellaneous costs for repairs that required opening the refrigeration system (including brazing supplies, vacuum pump, recovery equipment, etc)?

Explain Miscellaneous Cost

Service Agent Invoice: Attach copy of invoice here:*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.

Distributor Invoice Number*

Distrubutor Invoice: Attach copy of invoice here:*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.

Additional Comments

Use this field to explain differences between service agent invoice and distributor invoice.

Total Claim Amount*

This amount should match the amount on the distributor warranty claim invoice.

This form will be submitted to Icetro America.
For follow up, please email tech.support@icetroamerica.com.

This field is hidden when viewing the form

Icetro Claim Number

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