AIM Warranty Claim Form

Warranty Claim Form

Please Note: This form must be filled out in it's entirety to validate your claim
Contact Information
Name *

First Name Last Name
Company Name *
Company Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Claim Information

Please Fill Out Completely
Product Name *
Part Number *
Quantity *
Invoice Number of Original Purchase *
Date of Purchase *

Month Day Year
Date
Serial Number
If not applicable, simply input N/A - many claims will require serial number information and we may follow up to get that from you.
Description of Issue *
Please provide a detailed description of the problem you are experiencing with the part(s) entered above.
Detail Photo(s) *

The manufacturer will require photographic proof of the defective product to honor any claim. Shurflo pumps need a picture of the sticker on pump and picture with wires cut.
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Please verify that you are human *
Should be Empty:

Warranty Claim Form