WARRANTY FORM Manufacturer Warranty Request Form This field is hidden when viewing the formNext Steps: Sync an Email Add-OnTo get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.About YouYour Name(Required) First Last Company Name(Required)How Can We Reach You?We would love to chat with you. How can we get in touch?Email AddressPhone NumberPreferred Method of ContactEmailPhoneProduct DetailsLet's learn more about the product you want to warranty.Where did you purchase your item from?Fabtech SystemsFabtech Systems via OPIENorth American DistributorInternational DistributorFor international warranty service please contact the distributor you purchased the product from. What is your invoice number?Please upload your distributor proof of purchase.Max. file size: 40 MB. Please upload a copy of your invoice from the distributor you purchased from. What Item are you requesting a warranty for?Choose OnePDE SpringAdhesivesSomething ElseWhat item are you requesting a warranty for?What seems to be the problem?Item(Required)60SL60SS25SL25SS90SLC1LC1S602206050302203050What is the lot number?What seems to be the problem with your adhesive?Who manufactured the brace?In-house ManufacturingFabtech SystemsThird PartyWho is the third party manufacturer?What is the job number?The job number should start with F followed by 4 digitsWhat is your assessment of what went wrong?Faulty materialWrong category of springOtherOtherWould you like to move to a different category as a part of your warranty?What is the batch number.The batch number is a 4 to 8 digit number above the distal anchor.What was the the patient doing when the PDE failed?What is the patients current height?What is the patients current weight?Please upload one or more photos to help us see the issue:Accepted file types: jpg, jpeg, png, gif.Please provide a picture of the issue and the brace the PDE was mounted to. Please upload one or more photos to help us see the issueAccepted file types: jpg, jpeg, png, gif.Additional commentsAfter you submit your form someone will be in touch shortly.
