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Warranty Claim Form
ONLY FOR DISTRIBUTOR
Distributor Name / Branch
*
Contact Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Contractor Information
Installer Name
*
First Name
Last Name
Installer Company Name
*
Repair Date
*
-
Month
-
Day
Year
Date
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Find Product Type / Category
Product Type
*
Chinook
Heat pump central
Heat pump mini-split
Nortron
Supreme
Thermostat
Oil
Hydronic
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Product Information
Model Number
*
Serial Number
*
Installation Date
*
/
Month
/
Day
Year
Date
Unit Replacement?
*
YES
NO
Replacement Model
*
Replacement Date
*
-
Month
-
Day
Year
Date
Replacement Serial #
*
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Part(s) Details
Part #
*
Part #
Part #
Part #
Description of Issue
*
Please briefly describe the issue you are encountering.
0/500
Credit reference
*
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Maximum upload size 4MB
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