Warranty Claim Request

Please complete the MAXON Warranty Claim Form below. When you have completed all the required fields, press the "Submit" button to send your Warranty Claim Request. Our MAXON Customer Service Representatives will send the MAXON Claim Number assigned to your Warranty Claim Request to your email address.

Note: Fields with " * " must be filled.

Company Information :

Maxon Account #:

*Company Name:

*Contact Name:

*Telephone #:

( ) -

*Email:

Check if you do not have an email address

Warranty Claim Details:

*Repair Date:

/ /

*Customer Invoice #:

*Serial # :

*Model:

Repair Code:

*Repair Description :

Qty.

Price

Maxon Part # (enter "none" if labor only)

*1.

10.

11.

12.

*Total Price of Parts Claimed:

*Labor Hours:

*Labor Rate:

*Total Labor Claimed:

*Total Claimed:

Authorization Information :

Has Repair been Authorized?:

MAXON Authorization# :

MAXON Representative Name:

Part(s) Returned?

MAXON RMA # :

End User Information:

*Company Name:

Contact Name:

Address:

City:

Country:

Province/State:

Postal/Zip Code :

Telephone #:

( ) -