Claims / Warranty Form

Functionality

Is the End User Functional*
Yes / OuiNo / Non

Comments
If you have indicated "No" above. Please describe why they are not functional.

Company Info

Dealer Name/Rep Group*

Rep/Dealer Contact Name*

Rep/Dealer Contact#*

Email*

Project Info

Tayco Order#*

Customer PO#

Project Name / End User/Case Description*

Ship To Company*

Ship To Address*

City*

Postal / Zip Code*

Province/State*

Country*
CANADAUSA----------------------------------AFGHANISTANALBANIAALGERIAANDORRAANGOLAANTIGUA & BARBUDAARGENTINAARMENIAAUSTRALIAAUSTRIAAZERBAIJANBAHAMAS, THEBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBHUTANBOLIVIABOSNIA & HERZEGOVINABOTSWANABRAZILBRUNEIBULGARIABURKINA FASOBURUNDICABO VERDECAMBODIACAMEROONCENTRAL AFRICAN REPUBLICCHADCHILECHINACOLOMBIACOMOROSCONGO, DEMOCRATIC REPUBLIC OF THECOSTA RICACÔTE D'IVOIRECROATIACUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPTEL SALVADOREQUATORIAL GUINEAERITREAESTONIAETHIOPIAFEDERATED STATES OF MICRONESIAFIJIFINLANDFRANCEGABONGAMBIA, THEGEORGIAGERMANYGHANAGREECEGRENADAGUATEMALAGUINEAGUINEA-BISSAUGUYANAHAITIHONDURASHUNGARYICELANDINDIAINDONESIAIRANIRAQIRELANDISRAELITALYJAMAICAJAPANJORDANKAZAKHSTANKENYAKIRIBATIKOSOVOKUWAITKYRGYZSTANLAOSLATVIALEBANONLESOTHOLIBERIALIBYALIECHTENSTEINLITHUANIALUXEMBOURGMACEDONIAMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMAURITANIAMAURITIUSMEXICOMOLDOVAMONACOMONGOLIAMONTENEGROMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLANDSNEW ZEALANDNICARAGUANIGERNIGERIANORTH KOREANORWAYOMANPAKISTANPALAUPALESTINEPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPOLANDPORTUGALQATARREPUBLIC OF THE CONGOROMANIARUSSIARWANDASAINT KITTS & NEVISSAINT LUCIASAINT VINCENT & THE GRENADINESSAMOASAN MARINOSÃO TOMÉ & PRÍNCIPESAUDI ARABIASENEGALSERBIASEYCHELLESSIERRA LEONESINGAPORESLOVAKIASLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH KOREASOUTH SUDANSPAINSRI LANKASUDANSURINAMESWAZILANDSWEDENSWITZERLANDSYRIATAJIKISTANTANZANIATHAILANDTIMOR-LESTETOGOTONGATRINIDAD & TOBAGOTUNISIATURKEYTURKMENISTANTUVALUUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMURUGUAYUZBEKISTANVANUATUVATICAN CITYVENEZUELAVIETNAMYEMENZAMBIAZIMBABWE

Site Contact Name

Site Contact#

Site Contact Email

Case Name

Case Description
Give the case a name. Eg. Tayco Order#12345 - Bob's Office

Reason for Claim

Reason Category*
Damage (Concealed)Damage (Freight)Missing/Wrong ItemWarrantyWorkmanship

Replacement Parts Needed

Claim Item#1

Part#*

Description*

Qty*

Colour*

Issue#1*

Claim Item#2

Part#

Description

Qty

Colour

Issue

Claim Item#3

Part#

Description

Qty

Colour

Issue

Claim Item#4

Part#

Description

Qty

Colour

Issue

Claim Item#5

Part#

Description

Qty

Colour

Issue

Freight Delivery
Was the damage confirmed by signing the bill of lading? (Applicable to freight damage only)
No / NonYes / Oui

Supporting Documents*
To support your claim, please upload one of the following documents:

1. Images of the damaged product
2. Copy of the signed bill of lading that certifies visible damage
3. Supporting Documents and Inspection Reports

Please Note: That the claim may be denied due to insufficient supporting documents.

Send me a copy of my responses

Email address

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