Add-A-Motor, Inc.
Extended Warranty Claim Form
Please complete this form in its entirety. Incomplete forms may result in delays, cancellation of your warranty claim, or disposal of your submitted motor as outlined in the Add-A-Motor, Inc. Extended Warranty Terms & Conditions.
Customer Information
Today's Date: _______________________________________
Order Number: ______________________________________
Date of Purchase: ____________________________________
Purchased Warranty Length:
☐ 1 Year ☐ 2 Year ☐ 3 Year ☐ 4 Year ☐ 5 Year
☐ Other: ___________________________________________
Product Information
Product Name
(Example: Pet Door Motor, Drapery Motor)
______________________________________________________________________________________
Motor Product Code
(Located on the bottom left of the rear cover of the motor. Example: 955D20)
______________________________________________________________________________________
ECA / AAM Motor Identifier Number
(Located on the bottom right of the rear cover label.)
______________________________________________________________________________________
Problem Description
Please describe the issue you are experiencing with the motor.
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Return Shipping Address
Name
______________________________________________________________________________________
Company (if applicable) ______________________________________________________________________________________
Street Address
______________________________________________________________________________________
City ______________________
State _____________________
ZIP Code __________________
Country ___________________
Credit Card Authorization
Name on Card
______________________________________________________________________________________
Card Number
______________________________________________________________________________________
Expiration Date __________________
CVV __________________________
Billing Address
______________________________________________________________________________________
City __________________________
State _________________________
ZIP Code _______________________
Ship Warranty Claims To
Add-A-Motor, Inc.
Warranty Department
175 Appaloosa Ln
Valparaiso, IN 46383
Please ship your warranty claim to the address listed above.
Write your Order Number clearly on the outside of the shipping package.
This helps ensure your warranty submission is properly identified and processed upon arrival.
Important Shipping Instructions
Ship only the motor.
Do not send remotes, brackets, power supplies, mounting hardware, accessories, or any other components unless specifically instructed by Add-A-Motor, Inc.
Your warranty shipment must include:
☐ Motor Only (unless otherwise instructed)
☐ Copy of Original Purchase Receipt
☐ Completed and Signed Add-A-Motor, Inc. Warranty Claim Form
Failure to include the required documentation may result in delays or cancellation of your warranty claim.
Customer Authorization
By signing below, I certify that the information provided on this Warranty Claim Form is true and accurate.
I acknowledge that I have read and agree to the Add-A-Motor, Inc. Extended Warranty Terms & Conditions. I understand that Add-A-Motor, Inc. will determine whether my warranty claim qualifies for coverage. If my claim is determined not to be covered under the Limited Manufacturer's Parts Warranty, I authorize Add-A-Motor, Inc. to charge the credit card provided on this form for applicable replacement parts, return shipping, and authorized repair charges as outlined in the Warranty Terms & Conditions.
I understand that Add-A-Motor, Inc. is not required to contact me before processing such charges and that incomplete, inaccurate, or invalid warranty submissions may be denied according to the Add-A-Motor, Inc. Extended Warranty Terms & Conditions.
Customer Signature_____________________________________________
Printed Name _________________________________________________
Date ______________________