Warranty Submission Form

"*" indicates required fields

DD slash MM slash YYYY
Contact Name*
Business / Other Address*

Purchased from: Please Fill In Applicable*
Distributor/Importer
Reseller/Wholesalers
Retailer
Other
 
DD slash MM slash YYYY

Power Model: Select all applicable*
Was a Location Design Assessment Completed*

Project Environment: Select all applicable*

Date of Installation:*
Installation Address Same As Above*
If "NO" Please Complete Installation Address (REQUIRED)
Commissioning Person Name*
Clear Signature

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Solar Bollard Lighting
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