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.
Reference Case Number (if known)
You may have a case number from technical support. If so, enter it here.
System Part Number*
Chamber Serial Number*
Chamber Barcode*
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.
Déposer les fichiers ici ou

Taille maximum des fichiers : 200 MB.
Requested Compensation*
VIQUA Direct Customer Information
VIQUA Direct Customer Company Name*
VIQUA Direct Customer ID
*
Adresse postale Ville État / Province / Région ZIP / Code postal Pays
VIQUA Direct Customer Contact Name*
VIQUA Direct Customer Email*
VIQUA Direct Customer Phone*

VIQUA Direct Customer Information