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SCA NorCal Form

WAREHOUSE LOCATION - Location where parts are being returned

This Claim Form can NOT be used for Equipment Exchanges (to exclude CBP Evaporative Coils and Thermostats). Please contact your local Technical Support Manager for consideration.

YOUR COMPANY NAME

ACCOUNT NUMBER

YOUR PHONE NUMBER

YOUR COMPANY ADDRESS

CITY

STATE

POSTAL/ZIP CODE

HOME OWNER FIRST NAME/BUSINESS NAME

HOME OWNER LAST NAME / NA (THE NA IS FOR BUSINESS ONLY)

STREET ADDRESS

CITY

STATE

POSTAL/ZIP CODE

ORIGINAL HOME OWNER

APPLICATION TYPE

SELECT WARRANTY TYPE

BULLETIN NUMBER

SECONDARY HEAT EXCHANGER INSPECTION SHEET MUST BE FILLED OUT AND TURNED INTO BRANCH TO RECIEVE LABOR BENEFIT ON THIS BULLETIN.

UNIT MODEL#

UNIT SERIAL#

UNIT STARTUP DATE See counter associate if unsure of startup date.

FAILED DATE

REPAIRED DATE This date must be with in 60 days of returning your failed part.

Upload Required Documentation

Drop files here or

SERIAL NUMBERS OR DATE CODES ARE REQUIRED FOR ALL TSTAT. IF YOU HAVE ANY QUESTIONS OR IF YOU ARE UNSURE PLEASE CALL US.

FAILED PART NUMBER

FAILED SERIAL NUMBER / DATE CODES

BRAND

REPLACEMENT PART NUMBER

REPLACED SERIAL NUMBER

QTY

Click the plus (+) to add additional rows for Failed Part Numbers.

ORDER NUMBER, SHP #, INV #, OR PO NUMBER OF REPLACEMENT PART

SHIP TICKET (SHP) OF FAILED PART

SERVICE PERFORMED

COMMENTS

EMAIL ADDRESS

Additional email recipients - Send a copy of this claim to someone else in your office

TECHNICIAN NAME

I certify that all the provided information is true and correct to the best of my knowledge.

Your claims SCA/ID# will be emailed to the above address and is located in the subject of the email. Please ensure the SCA/ID# and your Dealer Name are written on all parts coming back to Sigler and you have attached a copy of the claim confirmation to the same parts. Please hold the warranty part at your office until credit is issued. If part is requested, it must be shipped back to the factory to receive credit.

PLEASE SELECT ONE

PART(S) HAVE BEEN RETURNED TO SELECTED BRANCH -

PART(S) HAVE NOT BEEN RETURNED (If your part(s) are not returned to Sigler, your warranty credit cannot be processed.)

SCA NorCal Form

SECONDARY HEAT EXCHANGER INSPECTION SHEET MUST BE FILLED OUT AND TURNED INTO BRANCH TO RECIEVE LABOR BENEFIT ON THIS BULLETIN.

SERIAL NUMBERS OR DATE CODES ARE REQUIRED FOR ALL TSTAT. IF YOU HAVE ANY QUESTIONS OR IF YOU ARE UNSURE PLEASE CALL US.

SMB 09-0024A

A COPY OF THIS CERTIFICATE MUST BE HELD AT THE DISTRIBUTOR WITH THE PART OR FURNACE. FOLLOWING PART OR FURNACE SCRAPPING, RETAIN THE CERTIFICATE FOR POTENTIAL FACTORY AUDIT.

COMBUSTION TEST CHECKLIST

INSTALLATION CHECKLIST - CHECK ALL AREAS EXAMINED PER SMB-09-0022

INSTALLATION CHECKLIST - CHECK ALL ITEMS CLEANED OR EXAMINED PER SMB-09-0022

AFTER INSTALLATION AND MAINTENANCE ITEMS CORRECTED - COMBUSTION RETEST

VISUAL INSPECTION OF SECONDARY HEAT EXCHANGER

IF FURNACE IS REPLACED PROVIDE REPLACEMENT MODEL AND SERIAL NUMBER

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