Warranty Claims

* All applicable fields must be completed to validate warranty claim
* One warranty claim per machine/serial number
* Claims received over 30 days from date of repair will be denied

Distributor Name & Address *

Owner Name & Address *

Start-Up Date
Repair Start Date
Repair Complete Date
Number of Trips

Make
Model
Assembly Serial Number
KNW Air End Ser. No. 1st Stage
KNW Air End Ser. No. 2nd Stage
QNW Air End Serial No.

Customer Complaint characters left

Discrepancies Noted characters left

Corrective Steps Taken characters left

Technician

KNW DATA
MACHINE TEMPERATURES (Deg F)		MACHINE PRESSURES (PSIG)
2nd Stage Discharge Temp		Intercooler Loaded Pressure
2nd Stage Suction Temp		Intercooler Unloaded Pressure
Lube Oil Temp		Lube Oil Pressure
1st Stage Discharge Temp		Aftercooler Discharge Pressure
Aftercooler Out Temp
Ambient Temp
MACHINE HOURS / CYCLES		CONDITION OF OIL AND DRAIN
Hours Running		Air Filter
Hours Loaded		Oil Filter
Cycle Counter		Intercooler Drain
		Aftercooler Drain
		Oil Level

OPERATING CONDITIONS & LOCATION
Clean Dirty Unknown	Inside Outside Unknown	Dry Wet Unknown

GENERAL MACHINE DATA
Nameplate Amps
Service Factor
Full Load Amps L1
Full Load Amps L2
Full Load Amps L3
Full Load Voltage L1 - L2
Full Load Voltage L1 - L3
Full Load Voltage L2 - L3
Safety Devices Tested
Vibration Levels
Belt Tension Alignment

K Series / QNW MACHINE DATA (Pressue = PSIG, Temp = Deg F)
Hour Meter		% Capacity
Air Temp (T1)		Oil Temp (T2) (Not on all models)
Oil Filter Pressure Before (Not on all models)		Oil Filter Pressure After (Not on all models)
Aftercooler Outlet Temp (T3) (Not on all models)		Aftercooler Outlet Pressure (P1)
Separator Filter Press Before (P2)		Separator Filter Press After (P3) (Not on all models)
Oil Level
Air Filter Condition

PARTS HELD WAITING INSTRUCTIONS?

Returned parts will not be accepted without an RGA number (PROVIDED BY ROGERS MACHINERY).
Disposal of part(s) without authorization may void the warranty.

PARTS LIST:

Qty	Part No.	Description	Check if Factory Supported	Cost	Ext Cost

TOTAL PARTS COST

Travel Labor	# Hours @	$ Per Hr	$
Labor On Job	# Hours @	$ Per Hr	$
Total Miles	# Miles @	$ Per Mile	$

GRAND TOTAL COST (LABOR, MILEAGE AND PARTS)

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Warranty Claims

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