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01635 523 713
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Extended Warranty Form
Extended Warranty Form
Application for an Extended Warranty
Please fill in the application below for an assessment of your extended warranty.
Customer Name
Business Name (if applicable)
Customer Address
*
Telephone Number
*
Email Address
*
Supplier Name
Supplier Address
Product Code
*
Batch Number/s
Quantity
*
Installation Date
Installation Address
*
Description of installation (Hospital, School, etc)
Average Daily Use (Hours)
Environmental Factors (Please Select)
*
IP rating suitable for environment
Outdoor (exposed)
Outdoor (sheltered)
Below -10°C
Above 35°C
Enclosed or restricted ventilation
Thermal insulation
Corrosive environment
Other
Lighting Controls (Please Select)
*
Occupancy sensor
Photocell sensor
Timer
Dimmer
DALI Dimmer
0-10V dimmer
Two-way switching
Wireless
Other
Confirm Info
Confirm Info
I confirm that the information given is true & accurate to the best of my knowledge
Confirm Terms
Confirm Terms
I have read and agree to the terms & conditions of the warranty policy, which can be found at www.kosnic.com/warranty-policy
Confirm No Marketing
Confirm No Marketing
I would not like to receive any further marketing information from Kosnic (UK) Ltd (Any personal information you give to us will be processed in accordance with the UK Data Protection Act 1998)
Confirm Changes
Confirm Changes
In understand that if the above stated condition change during the period of the warranty, Kosnic reserves the right to withdraw the warranty.
Comments
This field is for validation purposes and should be left unchanged.
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