Customer Information  
Customer #
 
Customer Name
 
Customer Order #
 
Promised Delivery Date
 
  Part Details  
Part #
 
Serial #
 
Part Description
 
Component #
 
Condition
 
Reason #
 
Reason For Removal
 
  Supplier Findings  
Confirm Discrepancies Reported
 
Additional Discrepancies Detected
 
Additional Problems
 
 
Comments
 
  Warranty Details  
Under Warranty
 
Warranty Claim On
 
Ref. Document Type
 
Ref. Document #
 
Warranty Claim #
 
Supplier Warranty Ref #
 
Warranty Notes
 
Claim Acceptance Status
Claim Accepted On
 
Reason