920-738-8187

Warranty Claims Form

This form is for Maytag and Gibson warranty claims.
A simple PDF version is available here > Get PDF Warranty Claim Form.

    WARRANTY CLAIMS FORM


    Nortek Global HVAC Contractor/Dealer Number:


    Contractor Company Name:

    Contractor Telephone:

    Contractor Address:

    Contractor City:

    Company State:


    Distributor Number:

    Distributor Name:

    Select one: EPAYLabor Credit

    Unit Serial Number (Both indoor and out if applicable):

    Unit Model Number and Brand Name of Equipment:


    Date Installed: < Click on Box to Select Date.

    Contact eMail:


    Enter Failed and Newly Installed Part Numbers (for more parts submit another form):

    1. Failed Part: Installed Part:

    2. Failed Part: Installed Part:

    3. Failed Part: Installed Part:

    4. Failed Part: Installed Part:

    5. Failed Part: Installed Part:

    6. Failed Part: Installed Part:

    Work Performed:



    THIS SECTION FOR COMPRESSOR/COIL/UNIT CHANGEOUTS ONLY


    Defective Model Number:

    Defective Serial Number:

    Replacement Model Number:

    Replacement Serial Number:


    MANUFACTURED HOUSING PRODUCTS ONLY:
    Enter Rate / Quantity / Totals

    Hourly Rate: $ / Qty: / Total : $

    Mileage: $ / Qty: / Total: $

    Refrigerant: $ / Qty: / Total: $


    RESIDENTIAL/COMMERCIAL PRODUCT ONLY:

    PAC Amount: $

    Enter Rate / Quantity / Totals

    Hourly Rate: $ / Qty: / Total : $

    Refrigerant: $ / Qty: / Total: $

    Homeowner Name:

    Homeowner Telephone:

    Homeowner Address:

    Homeowner City:

    Homeowner State:

    Homeowner ZIP:


    BE SURE TO DOUBLE CHECK ALL DATA BEFORE SUBMITTING