Claims form

Company Name

Customer Number (please see at Order Confirmation or Invoice)

Order Number

First Name *

Last Name *

Email *

Phone Number *

Address *

City *

Country *
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State/Province
—Please choose an option—Not a US addressAlabamaAlaskaAlbertaArizonaArkansasArmed Forces AmericasArmed Forces EuropeArmed Forces PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory

Zip Code *

What kind of problem do you have? *
ComplaintMounting damageReceived the wrong productTransport damageWarranty issueOther

Describe the problem as thoroughly as possible *

Company Name

Please indicate quantity of products / parts.

Please upload photos of the deviation found. *

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