Warranty Claim Form

 

I. Customer Information

 

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First Name:

Last Name:

Company:

 

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Address:

Suite/Apt::

 

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City:

State:

Zip Code:

 

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Email Address:

Contact Number:

 

II. Product and Purchase Information

 

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Date of Purchase:

Model Choose Option Digi-Beret Digi-Champ Other

Serial Number: Serial Number: :: A green number on the left of the back window frame, under the back safety lens.

 

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Where Purchased:

Vendor Address:

 

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Vendor City:

Vendor State:

Vendor Zip Code:

 

Reason for Claim:

 

Verification Code: