Date

Dealer's Distributor
Leave blank if you purchased directly from us

Dealer Name*

Street Address
Street Address 2 (Apartment/Suite #, Etc.)

City
State/County

ZIP/Postal Code
Country

Dealer Contact's Name*

Phone*

Email*

Customer's Name*

Street Address
Street Address 2 (Apartment/Suite #, Etc.)

City
State/County

ZIP/Postal Code
Country

Phone

Email

Date of Purchase*
Enter the date you purchased our product, as shown on your receipt

Grill Serial Number
Grill Size, Color, Class*

Part(s) Description*
What is the part that you are filing a claim for?
Part Number(s)
What is the part number of the item you are filing a claim for?

Description of Defect*

Photo Upload of Damaged Part #1
Clear File Photo Upload of Damaged Part #2
Clear File

Photo Upload of Damaged Part #3
Clear File

Proof of Original Purchase
Proof of original purchase is required for full warranty replacement. If left blank you may still qualify for half warranty replacements. (Examples of Proof: purchase receipt, credit card statement, check register with check #, date, and cost)
Clear File

Purchase Order (Optional)
The purchase order that goes along with this warranty claim.
Clear File

Processing and Fulfillment*
Please credit me for these replacement part(s) as applicable, I will provide the parts to the customer out of my stock.Please charge me as applicable and ship the replacement part(s) to me ASAP.Please charge me as applicable and ship the replacement part(s) to me with my next order.Please charge me as applicable and ship the replacement part(s) directly to the customer address provided above.

Word Quiz*
What letter does Saffire end with?

Image Quiz*
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Date

Distributor Name*

Street Address
Street Address 2 (Apartment/Suite #, Etc.)

City
State/County

ZIP/Postal Code
Country

Distributor Contact's Name*

Phone*

Email*

Dealer's Name*

Customer's Name*

This section is only required if you want us to ship the replacement parts to another address other than the distributor's.

Ship To ...
DealerDealer's Customer

Street Address
Street Address 2 (Apartment/Suite #, Etc.)

City
State/County

ZIP/Postal Code
Country

Phone

Email

End-User Date of Purchase*
Enter the date the dealer or the customer purchased our product, as shown on the end-user's receipt

Grill Serial Number
Grill Size, Color, Class*

Part(s) Description*
What is the part that you are filing a claim for?
Part Number(s)
What is the part number of the item you are filing a claim for?

Description of Defect*

Photo Upload of Damaged Part #1
Clear File Photo Upload of Damaged Part #2
Clear File

Photo Upload of Damaged Part #3
Clear File

Dealer's Purchase Invoice
Dealer's purchase invoice is required for consideration of free shipping on your claim.
Clear File

Customer's Proof of Original Purchase
Customer's proof of original purchase is required for consideration of free shipping on claims where the customer is the end-user (that is, the customer owns the grill and this claim is ultimately being made on the customer's behalf).
(Examples of Proof: invoice, purchase receipt, credit card statement, check register with check #, date, and cost)
Clear File

Purchase Order (Optional)
The purchase order that goes along with this warranty claim.
Clear File

Processing and Fulfillment*
Please credit me for these replacement part(s) as applicable, I will provide the parts to the dealer/customer out of my stock.Please charge me as applicable and ship the replacement part(s) to me ASAP.Please charge me as applicable and ship the replacement part(s) to me with my next order.Please charge me as applicable and ship the replacement part(s) directly to the ship-to address provided above.

Word Quiz*
What is five times five? (Answer using number characters only. For example, 0.)

Image Quiz*
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