Lamp 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.
Lamp Part Number*
Lamp Date Code*
The date code will be marked on the lamp beside the Hg symbol and be in the following format: #####-L## or #####-LL##
Purchase Date (end user)
MM slash DD slash YYYY
When and how did the lamp fail?*
Was a replacement part installed?
Did it fix the problem?
Upload Relevant Documents
Déposer les fichiers ici ou

Taille maximum des fichiers : 50 MB.
Images, videos, receipts
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