PPE Warranty Claim Form
PPE WARRANTY CLAIM FORM
Please complete all sections of this form.
Personal Information:
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Claimant Name: |
[Your Name] |
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Email Address: |
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Contact Number: |
Product Information:
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Product Name: |
[Safety Goggles] |
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Product Code/SKU: |
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Purchase Date: |
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[Month Day Year] Amount Paid: |
Claim Details
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Reason for Claim: |
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Description of Issue: |
The safety goggles purchased show signs of lens clouding after only a few weeks of use. |
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Has the product been repaired in any way? |
Declaration and Signature
I hereby declare that the information provided is true and accurate to the best of my knowledge and I agree to the warranty terms and conditions as set by [Your Company Name].
[Your Name]
[Month Day, Year]
