Online Warranty Claim Submission

This claim must be COMPLETELY filled in or it will be VOID. Once submitted, this form will be sent to service@degelman.com


* For internal use only


Customer



Product


Order

* For internal use only

Dealer


Distributor (if applicable)


Reason and Corrective Action Taken (PLEASE ATTACH AT LEAST ONE PICTURE)




No bigger than 5MB

No bigger than 5MB

No bigger than 5MB

No bigger than 5MB

Check all That Apply


Manufacturer's Use Only

* For internal use only


# Quantity Part # Item Description Invoice # Amount Total Manufacturer's use Only
1
2
3
4
5
6
7
8
9
10
11

Total Claim Request


Manufacturer's Use Only

* For internal use only
 
Parts
Labor
Freight
Sub-Total
Taxes
Credit