For Mi-T-M Dealer and Service Center Use Only

We can only process one claim per form. Please submit separate forms for each warranty claim you have.

*Denotes required fields.

Dealer Information

*Dealer Name:

Store Number:

*Account Number (max 8 numbers):

Work Order Number:

*Dealer Email:

*Dealer Phone - 10 digits, no dashes:

Product Information

*Model Number (max 15 chars):

*Serial Number (max 17 chars):

*Repair Parts Order Number: (max 7 numbers)

*Date of Sale:

Product Category:

Please Select Pressure Washers Air Compressors Generators Compressor Generators Portable Heaters Water Treatment Floor Care Equipment

Customer Information

Customer Name:

*Customer Phone - 10 digits, no dashes:

*Repair Date:

Issue Information

*Customer Complaint:

Repairs Performed:

Part Entry: *

*Part Number:

*Quantity:

*Dealer Net:

$

*Description:

Add Part

Mi-T-M Flat Rate Manual

Freight:

Labor Information

*Repair Labor Time (number of hours):

*Shop Labor Rate (per hour):

$

Repair Information

*Date of Claim:

*Service Manager Name: