Damage Claims Submission Form

Damage Claims Submission Form

Please fill out the form to report and track your damage claim.
Dealer Name*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Contact Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Model Number*
Serial Number
Climatic Invoice Number*
Was the Damaged Product Refused at Delivery?*

YesNo
Was the Damaged Product Noted on the BOL?*

YesNo
Date Product Received (or Refused)*

MonthDayYear
Date
Claim Request*

10% Damage Allowance15% Damage Allowance20% Damage AllowanceReturn Authorization RequestOther - please detail request below.
Description of Damage and Request (Return or Damage Allowance)*
Required Photos to Include with Damage Claim:
- Pictures of all 4 sides of the box
- Picture(s) of the actual damage
- Picture of the model/serial tag
Upload pictures of all 4 sides of the box:*

Cancelof
Upload picture(s) of the actual damage:*

Cancelof
Upload picture of the model/serial tag:*

Cancelof
Is a Replacement for the Damaged Item Requested?*

YesNo
By clicking Submit below, I acknowledge that I have read and understand the Damage Claims Policy embedded above.
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