Product claim form (distributor)

Name *

Email *

Phone No. *

CUSTOMER DETAILS:

SCANGRIP Customer No. *

Company *

Address line 1 *

Address line 2

Postcode *

City *

Country *

ClaimInfoStart

Invoice No. / Delievery note No.

Internal claim no. (if applicable) *

Purchase Date

CLAIM CONCERNS:

Item no. *

Product name *

Quantity *

Serial / Batch No. *

Find the Serial / Batch No.

Description of error on item *

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

ClaimInfoEnd

ClaimInfoStart

Invoice No. / Delievery note No.

Internal claim no. (if applicable) *

CLAIM CONCERNS:

Purchase Date

Item no. *

Product name *

Quantity *

Serial / Batch No. *

Find the Serial / Batch No.

Description of error on item *

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

ClaimInfoEnd

ClaimInfoStart

Invoice No. / Delievery note No.

Internal claim no. (if applicable) *

CLAIM CONCERNS:

Purchase Date

Item no. *

Product name *

Quantity *

Serial / Batch No. *

Find the Serial / Batch No.

Description of error on item *

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

ClaimInfoEnd

PRODUCT CLAIM FORM

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PRODUCT CLAIM FORM

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