Warranty/Returned Goods Claim Form (Distributors Only)

Fields marked by an asterisk * are required
Furnace Model No.*
Serial No.*
Spirit Part No.
Part Description*
Date Defective Part Removed/Replaced (mm/dd/yyyy)
Original Installation Date of Furnace/AC (mm/dd/yyyy)*
Did Distributor originally sell this unit?*
- Yes
- No
Reason for Warranty Claim*
Specific description of failure required. Do not use the word "Defective".
Your Debit Memo No.
Credit Amount Requested
Spirit Billing Account No.*
Distributor Name*
Distributor Street Address*
Distributor City*
Distributor State*
Distributor ZIP/Postal Code*
Distributor Phone Number (include area code & ext)*
Distributor Contact Name*
Distributor Email Address (for electronic reply)*
Homeowner Name*

Some coverages are only to the original homeowner
Homeowner Street Address*
Homeowner City*
Homeowner State*
Homeowner - ZIP/Postal Code*
* Required field.