Controller 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.
Controller Part Number*
Serial Number*
Serial number is 9 or 10 digits. If you require assistance locating the controller serial number, please contact Technical Support @ 1-800-265-7246
Purchase Date (end-user)
MM slash DD slash YYYY
Controller Alarm Sound*
Describe the failure. What was displayed on the controller?*
Was a replacement controller installed?
Did it fix the problem?
Upload Relevant Documents
Drop files here or

Max. file size: 50 MB.
Images, videos, receipts
Requested Compensation
VIQUA Direct Customer Information
VIQUA Direct Customer Company Name*
VIQUA Direct Customer ID
VIQUA Direct Customer Address
Street Address City State / Province / Region ZIP / Postal Code Country
VIQUA Direct Customer Contact Name*
VIQUA Direct Customer Email*
VIQUA Direct Customer Phone*

VIQUA Direct Customer Information