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Service Claim

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Service Claim ( service-claim )

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Capstone Service Claim Capstone Service Claim No. Capstone Turbine Corporation 6430 Independence Avenue Woodland Hills, CA 91367 service: (877) 282-8966 service@capstoneturbine.com Your Claim No. Name Address City State Postal Code Country Date Submitted: System Model: System S/N: Delivery Date: Commissioned Date: Failure Date: System Hours @ Failure: Repair Date: Type Warranty Policy Adjustment Product Improvement No. Failed Part Number: Failed Serial Number: Hours on Failed Part: Describe Failure, Cause, and Correction: Cost Detail Qty. PartNumber Description CostExtended Total Parts Other Other Labor Dealer Labor Dealer Travel Supporting documents or invoices must be attached. Grand Total Hours Rate Total Currency Submitted by: Signature:

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