Warranty Claim Form

WARRANTY

CLAIM FORM

Model Number*

Year of Construction*

Serial Number*

Equipment Owner*

Address*

Installation Date*

Date of Claim*

Service Company*

Technician Name*

Description of Malfunction*

Troubleshooting Performed*

Faulty Part(s) Identified*

E-mail*

Phone Number

Fields marked with an * are required

Please provide substantiating photos or supporting material of the malfunction. Failure to complete this form in its entirety AND provide substantiating evidence will result in the denial of the parts warranty claim. The damaged part MUST be returned to OMER USA, Inc., 3404 Oakcliff Rd., Suite C4-C6, Atlanta, GA 30340, at the Equipment Owner’s cost after the repair is completed to receive reimbursement.

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