Warranty

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Claim Type*
Requestor details
Requestor Name*
Company Name*
Requestor e-mail*
Requestor Phone*
I am the ...
- End Customer
- Service Provider / Contractor
Store Location
Store name
Store address
City
State
Postcode
Delivery Same location
- Delivery address the same as the store location
Delivery Address
Store name*
Store address*
City*
State*
Postcode*
Equipment details
Serial Number:*
Model Number*
Note: The above information is on the Rating plate affixed to the equipment
Description of Fault *
Description Fault*
Note: Please describe actions leading up to the fault and the fault itself. “Not Working”, “Faulty” or “Leaking” is not enough - We will need more specific information.
Image Supporting Claim - Rating Plate*
Images Supporting that Claim Rating Plate*
Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 128 MB.
Image Supporting Claim*
Affected part from a distance (wide angle)*
a. Damage part and faulty part as a close up *
b. Affected part from a distance (wide angle) *
Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 128 MB.
*
- I hereby certify by the submission of this claim form that the details contained therein are accurate and that the fault /damage was not caused by misuse, abuse or any modification that was not approved by Hussmann.