Warranty Claim Form

Warranty Claim Form
NOTE: All claims are subject to our trading Terms and Conditions found in our Product Catalogue, on our website www.taipan.com.au or click here to download our Terms and Conditions!
Customer & Purchase Details
Customer Name*
Date:*

DayMonthYear
Contact Name:*
Contact Number:*
Email:*
example@example.com
Taipan Invoice Number:*
Invoice Date:*

DayMonthYear
Return Method:*
Transport:*
CRM Name:*
Taipan Branch:*
By checking this box, you acknowledge and agree that this form data may be stored and processed in offshore locations. If you do not agree, please contact your local branch to discuss alternative submission methods.*

I AgreeI Disagree
Warranty Claim Details
Warranty Category

Hose AssemblyQuick Release CouplerCrimperHose FittingAdaptorOther
Part Number:*
(If hose assembly, use the hose part number)
Model Number:*
Batch Number:*
Serial Number:*
Hose Fitting 1:*
Hose Fitting 2:*
Operating Pressure (BAR):*
Flow Rate (LPM):*
Machine Type/Model:*
(Provide photos below)
Physical Crimp Dimension:*
Oil/Fluid Type:*
Oil/Fluid Temperature (℃):*
Time in Service (Months)*
Power Type (12v/24v/240v/Hand pump/ Foot pump):*
(Provide photos below)
Product Location:*
(Provide photos below)
Hose Location:*
(Provide photos below)
Description of Failure/Additional Information:*
File Upload (photos, video)

Cancelof

Customer & Purchase Details