Warranty Claim Form

Warranty Claim Form

This claim must be filled out completely in order to receive your warranty. All fields marked with an asterisk (*) must be completed to submit the form. If you do not have data for a particular form field, please use “n/a”.
Dealer Name*
Dealer Account Number*
Date*

MonthDayYear
Contact Name*
Dealer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*

Warranty Claim Form

Failed Part Information
Serial #*
Brand*
Model #*
Unit Install Date*

MonthDayYear
Number of Parts to Claim

Part 1
Part 1 Fail Date*

MonthDayYear
Defective Part #*
Replaced Part #*
Invoice #*
PO #*
Part Category*
Failure Reason
Examples: Burnt out, broken, leaking, cracked, plugged, corroded, connection misalignment, bolts/baffles loose, shorted/burnt, doesn't communicate, incorrect voltage, no flame, noisy, seized, shorted, or high amps.

Part 2
Part 2 Fail Date

MonthDayYear
Defective Part #
Replaced Part #
Invoice #
PO #
Part Category
Failure Reason
Examples: Burnt out, broken, leaking, cracked, plugged, corroded, connection misalignment, bolts/baffles loose, shorted/burnt, doesn't communicate, incorrect voltage, no flame, noisy, seized, shorted, or high amps.

Part 3
Part 3 Fail Date

MonthDayYear
Defective Part #
Replaced Part #
Invoice #
PO #
Part Category
Failure Reason
Examples: Burnt out, broken, leaking, cracked, plugged, corroded, connection misalignment, bolts/baffles loose, shorted/burnt, doesn't communicate, incorrect voltage, no flame, noisy, seized, shorted, or high amps.

Warranty Claim Form

Home Owner Information
Homeowner Name*
Homeowner Phone Number*
Please enter a valid phone number.
Homeowner Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Warranty Claim Form

System Information
Serial Identifier*

CoilCompressorTriangular Tube HeatFull UnitN/A
Older Serial #*
New Serial #*
Replacement Model #*
Serial #*
Should be Empty: