WARRANTY PARTS CREDIT REQUEST

FOR BLOWER ASSEMBLIES, BURNERS, BURNER CONTROL ASSEMBLIES, IGNITION CONTROLS, MOTOR ASSEMBLIES, VALVES AND WIRELESS THERMOSTATS

These parts require return to the factory for warranty credit. To receive credit, return the defective part along with the completed form. All lines must be completed. Incomplete forms will not be processed.

RETURN PART AND THIS COMPLETED FORM TO: Williams/Cozy Returns Department - 220 West Laurel Street • Colton, CA 92324

iF YOU ARE IN CANADA SEND COMPLETED FORM WITH PARTS TO: Ontor Limited • 12 Leswyn Road • Toronto Canada M6A 1K3

ALL OTHER PARTS:

Other warranty parts can only be obtained by e-mailing orders@wfc-fc.com for Williams or orders@cozyheaters.com for Cozy, or calling (888) 444-1212. Both the model and serial number of the unit are required before we can process any warranty order.

Company Name *

Branch Address *

City *

State / Province *

Zip Code *

Name of person completing form *

Email *

Phone Number *

P.O. Number *

P.O. Date * +

Installed Date * +

Installation Address *

City *

State / Province *

Zip Code *

Additional e-mails to receive copy of credit

ITEM 1

PART NO. *

QTY *

PRICE EA *

EXT $

0.00

MODEL NO *

SERIAL NO *

Attach File:

REASON FOR REPLACEMENT RETURN *

ITEM 2

PART NO.

QTY

PRICE EA

EXT $

0.00

MODEL NO

SERIAL NO

Attach File:

REASON FOR REPLACEMENT RETURN

ITEM 3

PART NO.

QTY

PRICE EA

EXT $

0.00

MODEL NO

SERIAL NO

Attach File:

REASON FOR REPLACEMENT RETURN

NOTES

CUSTOMER SIGNATURE *

clear

Date * +

Print Name *