warranty claim form

Thank you for reaching out to Heavy Truck Solutions. We regret to hear about the
issues you’re facing with your Leak Defender®. To expedite your claim, please complete
the warranty claim form below and a team member will respond within 24 to 48 hours.

If you have any questions or concerns about the warranty process, feel free to call us at
(602) 818-5741 or email us at sales@heavytrucksolutions.com. We’re here to assist you!

Personal Information

Full Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Email Address *

Product Details

Product Name *

Product SKU *

Place of Purchase *

Purchase Date *

Receipt Number or Purchase Order (if available)

Upload Purchase Slip *

Click or drag a file to this area to upload.

Claim Details

Type of Issue *

Description of Issue *

Image Upload

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Date Issue Noticed *

Desired Resolution *

warranty claim form

Personal Information

Product Details

Claim Details

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