Samson Agro - Warranty claim form !
Please fill in to apply for factory warranty - Do not return any goods before recieving confirmation and return documents from Samson Agro.

Only one machine and one repair per warranty claim.

If you want a copy for your own records, please pres "print" in your browser before you submit.

Your full name *
Your answer
Your Samson Agro costumer number *
Your answer
Your email addres *
Your answer
Your reference
E.g. your internal sales invoice number or service report number
Your answer
Serial number of the broken machine *
Your answer
Machine model *
Sales date - Date of delivery to end-user *
dd-mm-yyyy
Your answer
Date of receipt of complaint *
dd-mm-yyyy
Your answer
Date of repair *
dd-mm-yyyy
Your answer
End-user name *
Your answer
End-user address *
Your answer
End-user postal code *
Your answer
DOA (Defect On Arrival) *
Defect out of the box
Error code *
Please choose from list
Error description *
Please fill in detailed error description
Your answer
Performed work #1 (only if listed is performed)
Performed work #2 (only if listed is performed)
Labour
hours
Your answer
Driving time
hours
Your answer
Driving distance
km
Your answer
Freight cost
Local currency
Your answer
Spare parts - Samson purchase order number *
Purchase order on which spare parts has been purchased. If more than one order, please separate with a comma ","
Your answer
Replaced Samson part number #1
Your answer
Quantity #1
Your answer
Replaced Samson part number #2
Your answer
Quantity #2
Your answer
Replaced Samson part number #3
Your answer
Quantity #3
Your answer
Replaced Samson part number #4
Your answer
Quantity #4
Your answer
Replaced Samson part number #5
Your answer
Quantity #5
Your answer
Replaced Samson part number #6
Your answer
Quantity #6
Your answer
Replaced Samson part number #7
Your answer
Quantity #7
Your answer
Replaced Samson part number #8
Your answer
Quantity #8
Your answer
Replaced Samson part number #9
Your answer
Quantity #9
Your answer
Other parts
For parts without Samson part number. Screws, nuts, hydraulic hose and similar. Including cost for etch part
Your answer
Return freight cost
Costs for returning defect parts to Samson Agro Denmark. This cost only is covered if request for return is recieved from Samson.
Your answer
Pictures or other files *
Link to upload will appear when you submit the form
Submit
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