Complaint Form

Customer Information

Company Name

Adres

Adres c.d.

City/Town

ZIP/Postal Code

Państwo

Sold To

Ship to

Contact Email

Contact Phone

¹ sold to# / ship to# are indicated in all Pentair invoice or delivery forms

Product Information

Serial Number

² Alternatively you can put here the OC number, the WO number, the invoice number or you can select the picture of the Product Label here below

Product Label Picture

Product Number

Quantity of the Part Number claimed

Alleged Defect

³ Please be as specific as possible, indicate more details as example if there is a water leakage indicate where it is located. If it is from a connection or from a crack for example.

Replacement Product Number

Date of Recognition

Are there any 3rd party damages to report?

Yes

Other Intervention Date

If yes please indicate the reason and which components have been serviced or replaced if applicable

Was the warranty extension activated using Pentair Scan app?

Yes

When was the last planned maintenance?

Local Conditions

Installation Date

Inlet water source

Inlet Hardness (ppm)

Inlet [Fe] (mg/L Fe)

Inlet [Mn] (mg/L Mn)

Inlet TDS (ppm)

Inlet Turbidity

Inlet pressure (dynamic)

Inlet water temperature

Inlet condutctivity (µS)

Outlet conductivity (µS)

Room temperature

Pictures And Video

Annex

Annex Link

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Consent Statement

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