Warranty Application Date of Service Call* Name* Phone* Email* Address* City* US State* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming Zip Code* Technician Company Phone Address City US State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming Zip Code HVAC/R Unit Number* Serial Number* Numerical Rating of HVAC/R Unit Condition at Time of Servicing* 1 = Excellent2345678910 = Bad Visual check of unit condition. Is there evidence of increased corrosion since the last service maintenance call?* Yes No Coil/Fin area cleaned with MicroKleen PLC-1 (diluted 1:20)* Yes No Tap Water Hose Rinsed* Yes No Visual Check Of Unit Condition* Yes No Dated & Signed Unit Decal Recording Service Call* Yes No Additional Notes Send
