Customer Claim Request Form 📦

Customer Claim Request Form 📦

Please provide required details in order to assist in your Rapid Plas claim.
Customer Name

First NameLast Name
Contct Number
Please enter a valid phone number. MOBILE NUMBER ENTER AS NORMAL: 0402######Format: (000) 000-0000.
Email Address
example@example.com
Order or Tracking Number
Site Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Claim Type:
Claim For:
Delivery Date

MonthDayYear
Date
Product Name / Model
Tank Serial Number
Located in the Manufactorer's Badge on the tank
Tank Water Levcl %
Located in the Manufactorer's Badge on the tank
Type of Claim

Other
Reason for claim (Details)
Purchase Date

DayMonthYear
Date
Upload Proof of Purchase (Receipt, Purchase Order, etc)

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Upload Supporting Photos

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Should be Empty: