PRODUCT CLAIM FORM

Start your distributor claim. Please note, only use this form if you are a dealer.
For end-user claims, always use this form.

Name *

Email *

Phone No. *

CUSTOMER DETAILS:

SCANGRIP Customer No. *

Company *

Address line 1 *

Address line 2

Postcode *

City *

Country *

Invoice No. / Delievery note No.

Internal claim no. (if applicable) *

Purchase Date

CLAIM CONCERNS:

Item no. *

Product name *

Quantity *

Serial / Batch No. *

Description of error on item *

File upload (pictures of error) Supported file formats: JPG, PNG, DOC, PDF