Merangue Warranty Claim Form

Merangue Warranty Claim Form
* Only one claim per submission will be processed.
Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Address 1

Address 2

CityState / Province

Postal / Zip CodeCountry
Purchase Date

MonthDayYear
Date
Purchase City*
Product ID
Description*
Proof of Purchase Image*

Cancelof
Defective Product Image*

Cancelof
Security Check*
Should be Empty: