File a Claim - Pacmat

Claim Form Submission
A copy of this finished form will be sent to the following emails for your records.
Pacmat Rep Email*
Claim Submitter's Email*
RETAILER INFORMATION
Has the Dealer been onsite to view the claim?*
- Yes
- No
Dealer Name*
Dealer Contact Name*
Dealer Phone*
Dealer Email*
Retailer Address*
Street Address Address Line 2 City State ZIP Code
CONSUMER INFORMATION
Consumer Name*
Consumer Phone Number*
Consumer Email*
Consumer address*
Street Address Address Line 2 City State ZIP Code
PRODUCT INFORMATION
Product Name*
Product SKU*
Reference #*
Invoice #*
CLAIM INFORMATION
Date reported*
Date Format: MM slash DD slash YYYY
Submitted By:
Inspection Requested*
- Yes
- No
Does this require an inspection? If yes, please read our Inspection Agreement by clicking here. Should an inspection be required, the dealer will be responsible for the inspection fee in the case there are no manufacturing related issues.
Describe Issue*
Please upload photos or a short video (30 seconds or less) of your claim here:*
Drop files here or
CAPTCHA

Claim Form Submission