Panasonic | HVAC Specialty Warranty Request Return Form
(This Warranty form needs to be filled out per system)
1. Case Number : (If you do not have a case number, please call 888.932.4623 and request technical support)
*
2. Service Contractor
*
e. Service Contractor Email
*
example@example.com
3. Installation Site information
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
4. Dealer Information
*
5. Type of Warranty Claim
Complete Unit Replacement
Unit Repair Part
6. Part Number(s) Being Returned: (if this is a unit repair part, please provide us with the unit model number)
7. Panasonic Application Information
*
8. Installation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
9. Failure/Issue Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
10. Date of Repair:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
11. Description of Issue:
*
12. Take Issue Photos:
Submit
Should be Empty: