Warranty Claim Form

The RAASM USA Warranty Claim Form is to only be filled out by Certified RAASM USA Distributors.

All Claims submitted by Non-RAASM USA Distributors will be denied.
Distributor Company Name*
End User Company Name
Address of End User

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Part Number & QTY. (Example: 36161-55 QTY. 2)*
Serial # of Equipment*
Part Description
Length of Time In Service Before Failure:*
Part Failure Description*
Fluid being used:*
PSI to the Equipment:*
Comments about failure and the setup/specs of installation*
File Upload (Photos, Invoices, Info outside of the Warranty Form in correspondence to the Claim)

Cancelof
If claim is approved Distributor opts to receive one of the following:*

Replacement PartCredit to Account
Address where Replacement Equipment to be sent to if you selected to have Replacement Part.*
Reminder: Distributor to keep any defective part for 45 days or until otherwise instructed by Raasm. Note: I certify that the above information is correct. I understand that incomplete and/or unsigned claims will not be processed.
Email
example@example.com
Submitted By*

First NameLast Name
RAASM USA ACCEPTS THE CLAIM YN
Raasm Internal Use
SUBJECT TO RECEIPT OF ADDITIONAL INFORMATION YN
Raasm Internal Use
Should be Empty: