Claim Processing

Serial Number:

Wholesaler Information

Wholesaler Name:

Representative Name:

Street Address 1:

Street Address 2:

City:

State: Zip:

Phone:

Fax:

Email:

Installed:

Homeowner Information

Name:

Street Address 1:

Street Address 2:

City:

State: Zip:

Phone:

Fax:

Email:

Warranty Information

Fail Date: MM/DD/YYYY

Defect Type:

Install Date: MM/DD/YYYY

Indoor Model Number:

Indoor Serial Number:

Replacement Coil Information:

Please provide product registration information to get started.

THE MYLAR TAG IS REQUIRED. IF THERE IS NO TAG, THE WARRANTY CANNOT BE HONORED