DEFECT AND ASSEMBLY FORM Box 760, 275 Hespler Ave, Winkler, Manitoba R6W 4A8 T: (800) 418-9461 P: (204) 325-4195 F: (204) 325-8116 www.meridianmfg.com Name (Dealer or Assembly Person)(Required) Business Name(Required) Phone(Required) Email(Required) Brand(Required)MeridianModel Number (eg. SLMD1072, TL1039)(Required) Serial Number(Required) Date of Defect(Required) MM slash DD slash YYYY Photo of DefectParts missing or damaged (if any)Estimated/Actual Fix Summary(Required)CAPTCHANameThis field is for validation purposes and should be left unchanged.
