DEFECT AND ASSEMBLY FORM 170 Highway 83 North Benito, MB R0L 0C0 T: 1-866-459-0362 P: 866-459-0362 www.agshield.com sales@agshield.comName (Dealer or Assembly Person)(Required) Business Name(Required) Phone(Required) Email(Required) Brand(Required)Ag-ShieldModel Number (eg. 12-46-3)(Required) Serial Number(Required) Photo of DefectParts missing or damaged (if any)Estimated/Actual Fix Summary(Required)CAPTCHANameThis field is for validation purposes and should be left unchanged.
