By completing this form, you have requested your warranty claim be reviewed. If determined that that product failure has occurred within the applicable warranty period and is a result of a defect in materials or workmanship, a corrective action will be assigned and a Customer Service Representative will contact you regarding the warranty fulfillment process. Warranty PolicyName* Email* Phone*Address* City* Country / RegionUnited StatesCanadaMexicoSouth AmericaPlease Select State/ProvincePlease SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPlease Select State/ProvincePlease SelectAguascalientesBaja CaliforniaBaja California SurChihuahuaColimaCampecheCoahuilaChiapasFederal DistrictDurangoGuerreroGuanajuatoHidalgoJaliscoMéxico StateMichoacánMorelosNayaritNuevo LeónOaxacaPueblaQuerétaroQuintana RooSinaloaSan Luis PotosíSonoraTabascoTlaxcalaTamaulipasVeracruzYucatánZacatecasProvincePlease SelectAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonZip Code Is ship-to address is different from above Yes Address* Name/Company Name Address City State / Province / Region ZIP / Postal Code Phone Number* Products PurchasedDistributor Purchased From:* Approximate or Exact Date of Purchase* MM slash DD slash YYYY Detailed explanation of what caused the damage.*Qty and Part Number or Description of damaged pieces.*Qty.Part Number Seat Serial # (Either a 6 digit # found on the front left side of the seat base -OR- 10 digit # found on the left side of the seat base) HiddenUpload Photo*Max. file size: 128 MB.Upload Photo(s)* Drop files here or Select files Accepted file types: jpg, png, Max. file size: 128 MB, Max. files: 30. Upload InvoiceMax. file size: 128 MB.HBB employee submitted:Select your nameAngela OcampoBlair SeedChris JohnsonDarrel WilsonDavid CoyleDerek QuysGarry FournierHoracio MendozaIrineo De La GrazaJaime De La PazJosé AlanisJulian HansenKyle FelthamLuis SillerMatt HullManuel RodriguezMichael TruittRichard MayerRyan FleischhackerScott WeeseTim MayTyler BlaedornEmailThis field is for validation purposes and should be left unchanged.