Chamber Failure Claim Form - VIQUA

Complete the form below, or download as a PDF and email the form to VIQUA Technical Support for processing.

Chamber Failure Claim Form

Please note that this form is for direct VIQUA customers only. For indirect customers or end users, please contact your dealer or VIQUA support.
Reference Case Number (if known)
You may have a case number from technical support. If so, enter it here.
Chamber or System Part Number
Serial Number from Chamber
How has the chamber failed?
- Pin hole
- Leaking from weld
- Leaking from gland nut or sleeve bolt
- Dented
- Corroded
Upload Relevant Documents
Images, videos, receipts (max. 200MB)
Drop files here or
Requested Compenstation*
Dealer Information
Dealer Company Name*
Dealer Customer ID
Street Address City State / Province / Region ZIP / Postal Code Country
Dealer Contact Name*
Dealer Email*
Dealer Phone*

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Replacement Lamps and Parts

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