Warranty Application Form
All fields marked with * are required and must be filled.
1. Only one claim per submission will be processed. 2. Pictures of the claim are mandatory for us to evaluate. 3. It is in our right to disapprove any claim request that is found incorrect or fraudulent.
Customer Details
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Customer Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Purchase Details
Order Number
*
Receipt Attachment
*
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Purchase Date
*
Delivery Date
*
Product Code and Description
*
Describe the Issue
*
Claim Reason
*
Fault
Damage
Images & Videos
*
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of
Compliance Certificate Natural Gas
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Submit
Should be Empty: