Warranty Form

Contact Name*:

Company Name*:

Phone Number:

Email*:

Street Name*:

City*:

State*:

Zip/Postal Code*:

Country*:

Quantity*:

Claim Description*

Point of Purchase*:

Part Number*:

Filter Date Code:

sometimes found on the dome of the cannister

Filter Date in Service*:

Filter/Part Failure Date*:

Filter Miles/Km/Hours:

enter number value here and choose the units below

Engine Serial Number:

Equipment Make/Model:

Equipment VIN:

Engine Miles/Km/Hours:

enter number value here and choose the units below

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.

Currency*:

Part Amount*:

Total Labor Amount*:

Incidental Part Amount*:

Handling and Shipping*:

Other Amount*:

Total Claim Amount*:

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