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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
Contact Name*
example@example.com
Additional Email
F.e. Supervisor email
example@example.com
Do you want the part to be shipped to a different address?
F.e. Different warehouse or directly to the end user
Shipping Address

Other Information

Reseller Sales Person
Reseller or Picote Order Number
Was this purchased within the past 12 months?*
Copy of Receipt / Invoice
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?*
File*
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
File 1*
No File Chosen
File uploads may not work on some mobile devices.
File 2*
No File Chosen
File uploads may not work on some mobile devices.
File 3*
No File Chosen
File uploads may not work on some mobile devices.
File 4*
No File Chosen
File uploads may not work on some mobile devices.
File 5*
No File Chosen
File uploads may not work on some mobile devices.
File 6*
No File Chosen
File uploads may not work on some mobile devices.
File 7*
No File Chosen
File uploads may not work on some mobile devices.
File 8*
No File Chosen
File uploads may not work on some mobile devices.
File 9*
No File Chosen
File uploads may not work on some mobile devices.
File 10*
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
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.
File 1*
No File Chosen
File uploads may not work on some mobile devices.
File 2*
No File Chosen
File uploads may not work on some mobile devices.
File 3*
No File Chosen
File uploads may not work on some mobile devices.
File 4*
No File Chosen
File uploads may not work on some mobile devices.
File 5*
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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