CREDIT REQUEST

Status

Account Name

Initiator

Reason for Return

Product Information

Entire Order?

YesNo

Part Details

Enter the Part Number and Quantity. Example: (12345, 2), (23456, 10)

Need Replacement Order?

YesIf you have already contacted Customer Care to request a replacement, selecting this option may create a duplicate order. Please uncheck the box if a replacement request has already been made through other OmniMax personnel.

Attachment(s)

Requires Pictures - Attachment Required (File can not exceed 25 MB)

*Attachment is Required if Damaged Product or Warranty Repair is selected as Reason for Return

*For Warranty Claims pictures, invoices, and warranty information required or claim may be rejected.

*For Damaged Product / Incorrect Product pictures and copy of invoice are required.

Description Of Issue

Product Line

Product Type

SidewallRoofOther

Roof Square Footage

Number of Panels

Sq Footage of Sidewalls

Description for "Other"

Color (List all colors)

Is the building owner the original purchaser?

Is the site address different from the building owner's info?

Site Address Information

Site Street Address

Site City

Site State

Site Postal Code

Month and Year Material Delivered

Month and Year Installed

Date the problem was first noticed

Omnimax Customer Information

Customer Name

Customer Street Address

Customer City

Customer State

Customer Postal Code

Customer Phone Number

Customer Email

Customer Contact

Is Installer address same as Omnimax Customer address?

Installer Information

Installer Name

Installer Street Address

Installer City

Installer State

Installer Postal Code

Installer Phone Number

Installer Email

Installer Contact

Home Owner Information

Home Owner Name

Home Owner Street Address

Home Owner City

Home Owner State

Home Owner Postal Code

Home Owner Phone Number

Home Owner Email

Contact Name

Contact Email

Contact Phone

Sales Order Number

PO Number

Invoice Number

Invoice Date

Credit Total Requested ($)

Contact Information