Dealers Name & Account #
Dealers Phone #		Consumers Name
Date Purchased		Consumers Phone #
Date Received		Date Purchased
Purchased Order #		Date Received
Model #		Consumers address
Serial #

Please describe in detail of problem:

FOR OFFICE USE ONLY

Date Received Quantity Received Model # Received Serial # Received Action Taken To Resolve QA:     Part # Used Qty Used Part Cost Freight Cost Shipping List # Special Notes

QUALITY ALERT FORM MUST BE FILLED OUT COMPLETELY TO AVOID ANY DELAYS IN PROCESSING.