Panasonic Warranty Claim Form

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

CityState / Province

Postal / Zip Code
4. Dealer Information*
Complete Unit ReplacementUnit 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

MonthDayYear
Date
9. Failure/Issue Date:

MonthDayYear
Date
10. Date of Repair:

MonthDayYear
Date
11. Description of Issue:*
12. Take Issue Photos:
Should be Empty:

Panasonic | HVAC Specialty Warranty Request Return Form