Page 746 - Catalog filters BALDWIN for cars

Auto Parts / FIELD REPORT FORM

DISTRIBUTOR EQUIPMENT OWNER
Company Name ______________________________ Company Name___________________________________
Address ____________________________________ Address _________________________________________
City ________________________________________ City_____________________________________________
State ________________ ZIP___________________ State _________________ ZIP ____________________
Contact Contact
Person ______________________________________ Person _________________________________________
Phone _______________________________________ Phone __________________________________________

Filter Installation Removal
Number ________________________ Date ________________________ Date _________________________
Repair Shop Cost of
Name _______________________________________ Repairs $ ________________________________________
(ATTACH ITEMIZED REPAIR BILL)
Street _______________________________________ Contact _________________________________________
City _________________________________________ Phone __________________________________________
State ________________ ZIP___________________ FAX ____________________________________________

EQUIPMENT Model___________________ Year ___________ Serial No. _________________________
Type of
Equipment ___________________________________ Make ___________________________________________
Damaged Part Total Miles or
(Engine, Pump, Etc.) ___________________________ Hours on Unit ____________________________________

AIR FILTER Has the system recently been worked on? _________________________________________
Has the filter Miles/Hours Oil Sump
been washed? ___________________ on Oil ________________________ Capacity ______________________
Pressure/Restriction Gauge reading at removal ______________________________ (psi/inches of H O/Mercury)
2
Usual Filter Change Interval ________________________________________________________ (Miles/Hours)

COOLANT How often is the system tested? __________________________________________________
Type of Cooling System Type of
Antifreeze Used __________________ Capacity ______________________ SCA Used ____________________
Cooling System Last Cleaned ________________________________________________________(Miles/Hours)

OIL/HYDRAULIC Has the system recently been worked on? _________________________________________
Type of Oil Sump Miles/Hours
Oil _____________________________ Capacity ______________________ on Oil ________________________
Usual Oil Change Interval __________________________________________________________ (Miles/Hours)

FUEL Has the system recently been worked on? _________________________________________
Type of Miles/Hours Fuel System
Fuel ____________________________ on Filter ______________________ Pressure _____________________

PLEASE USE A SEPARATE PAGE TO DESCRIBE WHAT HAPPENED!
Signature of Signature of
Distributor ____________________________________ Owner __________________________________________
Please send this Report, any Repair Bills, Explanation, Oil/Coolant Samples and Filters to:

ATTN: SERVICE ENGINEERING
BALDWIN FILTERS
4400 E Hwy 30
Form 387 Kearney, NE 68847

744 / Auto Parts

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