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Reason for Claim

i.e. Part replacement under warranty, Part replacement outside warranty, item missing from order, wrong item delivered/ordered

Contact Information

Company Name
Company Name
Company Name
Contact Name*
example@example.com
Shipping Address*
Billing Address Same as Shipping Address*
Billing Contact
example@example.com
Billing Address*

Other Information

Reseller Sales Person
Reseller or Picote Order Number
Was this purchased within the past 12 months?*
No File Chosen
File uploads may not work on some mobile devices.
Receipt/Invoice required for warranty claims

List of missing, damaged or incorrect items

Please write a list of missing / incorrect items or attach a file with missing / incorrect items listed.

Do you want to attach a file or write a list?*
No File Chosen
File uploads may not work on some mobile devices.
Attach a file listing missing, damaged or incorrect items
Remember to add item quantity
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.

Product Details

i.e. Maxi Miller, Mini Pump, Mini Cleaner, Original Chain DN100
Machine serial number
i.e. Generator type, 110v, etc.
Picote or Reseller product/part number

Description of fault

(Noise, shake, overheating, cable twisting, etc.)
i.e. Liner removal, coating, etc.
Number of hours
Is this a recurring problem?*
i.e. 30 mins, 3 hours, etc.
Was the operator trained for the usage of the equipment?*
Has repair been attempted already?
Additional description of the issue.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.

Service Information

Date/Time*
Monitor name
Maxi Miller, Mini Pump, etc.
Name*
i.e. Description of fault or issue
Product Number
Product Number
Product Number
Product Number
Product Number
Product Number
Product Number
Product Number
Product Number
Product Number
Product Number
Product Number
Product Number
Product Number
Product Number

Warranty (confirmation)

Name*
Is warranty valid?*
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