Parts Online System
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*authorized dealers only
Lay-Mor 401 Capacity Drive Longview, TX 75604
Toll Free: 800.323.0135
LAY-MOR WARRANTY CLAIM FORM
* Required Field
*
Claimant:
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Owner:
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Address:
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Address:
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City:
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City:
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State:
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State:
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Zip Code:
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Zip Code:
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Phone:
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Phone:
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Email Address
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Unit Serial Number:
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Authorization Number:
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Date in Service:
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Date Repaired:
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Hour Meter Reading:
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Labor Rate:
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Details of Owner Complaint
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What Failed (Include Description, Part Number, Part Cost)
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Service Work Performed (Include Description & Labor Hours)
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Select Reimbursement Method
Credit Account
Pay by Check
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Total Claim Amount:
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Issue Credit/Check to
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Account Number
