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
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District of Columbia
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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
*
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)
*
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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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