If you are human, leave this field blank.** Submission Guidelines **– This application must be completed IN FULL, otherwise it will be returned and no credit given. Distibutor NameDealer Name *Dealer Contact NameDealer Email AddressDealer Phone NumberAppliance Owner *Owner's Street AddressCityStateZip CodeName of Model and Type *Serial # *Date of Installation *Date failure was reported to Dealer *Description of failure or problem *Please be detailed and specific. Diagrams of installtions and/or venting configurations are very useful when technical staff are trying to spot trends or trying to help dealers analyze problems. Please complete the below information as mush as possible and also attach any photographs, documents or other information to assist.** Please Note **Work must be completed within 3 months of report or claim will be denied. – After the dealer submits this form to the distributor, the distributor will approve this application by signing it and forwarding it for crediting. – If this form is not complete or is without a color photo, it will be returned and no credit will be given. – Some distributors may have a minimum number of units to be ordered before a dealer is qualified for a burn unit credit. – Please contact your Master Heat Sales Representitive for a comprehensive explanation of the Burn Unit Credit process. Photo, drawing or image #1Photo, drawing or image #2Photo, drawing or image #3Photo, drawing or image #4Photo, drawing or image #5Parts required: Dealer - List here with part numbersFirst Part NeededSecond Part NeededThird Part NeededFourth Part NeededFifth Part NeededIn order for the warranty to be in effect, unit must be registered with the manufacturer. The warranty is stated in the Owner\’s manual. Select one *No, I don\'t need the partYes, I need the partPO# *reCAPTCHA is required.Submit
