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Warranty Claim Form
ONLY FOR DISTRIBUTOR
Distributor Name / Branch
*
Customer Number
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
Repair date
*
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Find Product Type / Category
Product Type
*
Gas / Propane - Chinook
Electric / Heat Pump
Hydronic Air Handler
Oil
Ductwork - Smart Duct System
Thermostat
Electric Product Name
ACD
Alize
DCAH
Gree
Hydra Industriel
Hydra Mechanical
Hydra Revolution
Hydra III
Nortron
Supreme
Oil Product Name
Accessories
AMP
AMT
CMO
HMR
HMT
OLB
RHB
RLB
Roth Oil Tank
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Product Information
Model Number
*
Serial Number
*
Install Date
*
-
Month
-
Day
Year
Date
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Part(s) Details
Number of parts concerned
Part #
*
Part #
*
Part #
*
Part #
*
Description of Issue
*
Please briefly describe the issue you are encountering.
0/500
Debit Memo
*
Upload a File
Maximum upload size 4MB
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of
Detail Photo
Upload a File
Maximum upload size 4MB
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Unit Replacement?
*
YES
NO
Replacement Date
*
-
Month
-
Day
Year
Date
Replacement Model
*
Replacement Serial #
*
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*
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