DS SPA COMPONENT OR PLUMBING CLAIM FORM

Spa Serial Number:*
Spa INSTALL Date:*

MonthDayYear
Date
Spa REPAIR Date:*

MonthDayYear
Date
Dealer's Name:*
Company that is submitting the claim.
Dealer's Email:*
A confirmation of this claim submission will be sent to this email address.
Dealer's Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dealer's Phone Number:

Area CodePhone Number
Dealer's Dynasty Account #*
Typically starts with a “P” or "G"
Customer's Full Name:*

First NameLast Name
Customer's E-mail:*
example@example.com
Customer's Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Customer's Phone Number:*

Area CodePhone Number
Customer's complaint:*
Ensure details and accurate information is provided, so defects can be properly addressed with our quality team and suppliers.
Service preformed:*
Ensure details and accurate information is provided, so defects can be properly addressed with our quality team and suppliers.
List any part numbers used for the repair:*
If unsure of the part number/s use NA in this box. A dynasty Spas representative will attempt to identify the part/s by using the pictures provided or contact you for more information.
Repair START Time:*

:HourMinutesAM/PM Option
Repair END Time:*

:HourMinutesAM/PM Option
Repair time/labor hours are paid according to the pay schedule for typical repairs. If you are requesting additional time, please provide details to justify the additional time required or request preapproval from the warranty department prior to performing the repair. Please refer to your dealer manual to voew the pay schedule or contact tthe warranty department to receive a copy at: warranty@dynastyspas.com
Image / File upload:*

UPLOAD HERE
Picture clearly showing part defect and/or label/s. Cancelof
Image / File upload:

UPLOAD HERE
2nd picture clearly showing any additional defects and/or label/s. Cancelof
Image / File upload:*

UPLOAD HERE
Any additional supporting file or picture. Cancelof
Additional Notes
Should be Empty: