Warranty Claims 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

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