Standard Warranty Claim

Standard Warranty Claim
DEALER SECTION – AREAS WITH A * NEED TO BE FILLED OUT TO FILE CLAIM (COMPRESSOR INFO. ONLY REQUIRED IF FILLING COMPRESSOR CLAIM)
Dealer Name*
Dealer Number*
Email Address*
example@example.com
Unit Serial Number*
Unit Model #*
Start Up/Install Date*

MonthDayYear
Date
Date Unit Failed*

MonthDayYear
Date
Purchase Order #
Consumer Name*
Consumer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Add Parts
New Part #*
Failed Part #*
New Part #
Failed Part #
COMPRESSOR INFORMATION
Compressor Claim

YesNo
New Compressor Serial #
Failed Compressor Serial #
A PICTURE OF THE FAILED COMPRESSOR TAG MUST ACCOMPANY ALL COMPRESSOR CLAIMS – IF THIS IS NOT INCLUDED THE CLAIM WILL BE DELAYED/DENIED.
Picture

Cancelof
Should be Empty:

DEALER SECTION – AREAS WITH A * NEED TO BE FILLED OUT TO FILE CLAIM (COMPRESSOR INFO. ONLY REQUIRED IF FILLING COMPRESSOR CLAIM)