Warranty Form
Customer Information
Contact First Name*:
Contact Last Name*:
Company Name*:
Phone Number:
Email*:
Street Name*:
City*:
State*:
Zip/Postal Code*:
Country*:
--None--
USA
Canada
Mexico
Australia
New Zealand
China
Japan
Korea
Singapore
Malaysia
Thailand
Cambodia
Laos
Vietnam
Philippines
Sri Lanka
Bangladesh
United Kingdom
Ireland
France
Spain
Italy
Switzerland
Portugal
Turkey
Belgium
Netherlands
Luxembourg
Germany
Austria
Denmark
Norway
Sweden
Finland
Iceland
Faroe Islands
Aland Islands
Estonia
Belarus
Latvia
Lithuania
Ukraine
Poland
Czech Republic
Slovakia
Hungary
Romania
Moldova
Slovenia
Croatia
Bosnia and Herzegovina
Montenegro
Serbia
Bulgaria
Kosovo
Albania
Macedonia
Kazakhstan
Uzbekistan
Turkmenistan
Kyrgyzstan
Tajikistan
Georgia
Armenia
Azerbaijan
Russia
South Africa
Guatemala
Honduras
El Salvador
Nicaragua
Costa Rica
Panamá
Colombia
Ecuador
Venezuela
Bolivia
Uruguay
Paraguay
Argentina
Chile
Perú
Brazil
Indonesia
Others
Claim Information
Quantity*:
Claim Description*
Point of Purchase*:
Part information
Part Number*:
Filter Date Code:
sometimes found on the dome of the canister
Application information
Filter Date in Service*:
mm/dd/yyyy
Filter/Part Failure Date*:
mm/dd/yyyy
Filter Miles/Km/Hours:
enter number value here and choose the units below
--None--
Miles
Km
Hrs
Engine Serial Number:
Equipment Make/Model:
Equipment VIN:
Engine Miles/Km/Hours:
enter number value here and choose the units below
--None--
Miles
Km
Hrs
Please follow the steps below:
Fill out the Warranty Form:Cummins Filtration will send you a RMA #
The invoices, pictures and any other information should be attached in the subsequence in the email response once the claim has been acknowledged which will help adjudicate the claim.
Box the return filter using an appropriate fluid tight container where necessary.
If you are filling out this form on behalf of an end user, please use your contact information under the "Customer Information" section.
Amount Claimed by Customer
Currency*:
Algerian Dinar
Angola Kwanza
Argentine Peso
Australian Dollar
Bahraini Dinar
Bangladesh Taka
Bolivian Boliviano
Brazilian Real
British Pound
Canadian Dollar
CFA Franc (BCEAO)
Chilean Peso
Chinese Yuan
Colombian Peso
Costa Rica Colon
Czech Koruna
Danish Krone
Euro
Ghanaian Cedi
Guatemala Quetzal
Honduras Lempira
Indian Rupee
Indonesian Rupiah
Japanese Yen
Kenyan Shilling
Korean Won
Kuwaiti Dinar
Malaysian Ringgit
Mexican Peso
Mongolian Tugrik
New Zealand Dollar
Nigerian Naira
Norwegian Krone
Papua New Guinea Kina
Paraguayan Guarani
Philippine Peso
Polish Zloty
Qatar Rial
Romanian Leu
Saudi Arabian Riyal
Serbian Dinar
Singapore Dollar
South African Rand
Swedish Krona
Taiwan Dollar
Thai Baht
Turkish Lira (New)
U.S. Dollar
UAE Dirham
Uruguayan Peso
Venezuelan Bolivar Fuerte
Vietnam Dong
Part Amount*:
Total Labor Amount*:
Incidental Part Amount*:
Handling and Shipping*:
Other Amount*:
Total Claim Amount*:
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