Client Contact Form

*** Please Provide Contact Information Of The Person Who Should Receive All Communication For This Request

Legal Company Name(Required)

Contact Full Name(Required)

First Last

Email(Required)

Phone(Required)

BILLING Address(Required)

Street Address Address Line 2 City State / Province ZIP / Postal Code Country

SHIP TO Address - If different from billing address

Street Address Address Line 2 City State / Province ZIP / Postal Code Country

Which Company did you Purcahse the unit from?

Purchase Date

Order or Invoice #

Name of Sales Rep

Sales Rep Contact Information

Proof of Purchase

Max. file size: 256 MB.

Product Serial Number and Description of Damage/Defect *(Required)

Include Air Purifiers and Filters with Damage/Defect Description

Images/Video of Defect

If you have a link to videos, please add it to the description area above

Drop files here or

Max. file size: 256 MB.

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