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Capstone

Service Claim

Capstone Service Claim No.

Capstone Turbine Corporation 6430 Independence Avenue Woodland Hills, CA 91367 service: (877) 282-8966 service@capstoneturbine.com

Your Claim No. Name

Address

City State Postal Code Country

Date Submitted:

System Model: System S/N: Delivery Date: Commissioned Date: Failure Date: System Hours @ Failure: Repair Date:

Type

Warranty

Policy Adjustment Product Improvement No.

Failed Part Number: Failed Serial Number: Hours on Failed Part:

Describe Failure, Cause, and Correction:

Cost Detail

Qty. PartNumber Description CostExtended

Total Parts

Other Other Labor Dealer Labor Dealer Travel

Supporting documents or invoices must be attached.

Grand Total

Hours Rate

Total

Currency Submitted by:

Signature:

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