Name: %NAME%
Address: %ADDRESS%
CityState: %CITYSTATE%
Zip: %ZIP%
Country: %COUNTRY%
Phone: %PHONE%
EmailAddress: %EMAILADDRESS%
Preferred Method Of Contact: %PREFERREDMETHODOFCONTACT%
Date Purchased: %CALENDAR1%
Part Number: %PARTNUMBER%
Store Purchased: %STOREPURCHASED%
Installed By: %INSTALLEDBY%
ReasonForClaim: %REASONFORCLAIM%
If Other Please Give Details: %IFOTHERPLEASEGIVEDETAILS%
Nature Of Your Problem: %NATUREOFYOURPROBLEM%
Nature Of Warranty Claim: %NATUREOFWARRANTYCLAIM%