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.
Chamber or System Part Number*
Reference Case Number (if known)*
You may have a case number from technical support. If so, enter it here.
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) Please note pictures are required.
Drop files here or
Requested Compensation*
VIQUA Direct Customer Information
VIQUA Direct Customer Company Name*
VIQUA Direct Customer ID
*
Street Address City State / Province / Region ZIP / Postal Code Country
VIQUA Direct Customer Contact Name*
VIQUA Direct Customer Email*
VIQUA Direct Customer Phone*

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Replacement Lamps and Parts

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