Warranty Claim Form

			*Indicates Mandatory Fields
*Sold To Company Name:	*Contact Name:
*Address:	*Phone Number:
*City:	*Sales Order or Purchase Order Number: (located under seat)
*State:	Invoice Number:
*Zip Code:	Order Date:

		Reason for Replacement:
Chair Part Description:	Qty:
Chair Part Description:	Qty:
Chair Part Description:	Qty:


Ship to Company Name:	Contact Name & Phone Number:
Address:	City:
State:	Zip Code:

Upload Photo:
Upload Photo:
Upload Photo:


To complete a Warranty claim, please refer to the following instructions: For missing parts, send completed Warranty Order Form along with a copy of the sales order acknowledgement to any of the contact sources as noted below. If component replacement and/or repair work is required, please submit digital photos representing the damage along with a completed Warranty Order Form and copy of the sales order acknowledgement to any of the contact sources as noted below. If photos cannot be supplied, it may be necessary to ship the defective item. Please contact Customer Service directly for instructions. Sources of contact: E-mail: loism@encoreseating.com Fax: 562.926.1963 Address: 13747 Midway Street, Cerritos, CA 90703