Warranty Claim Form

Warranties

Please fill out the below form and we will contact you in the next 24-48 hours.

Todays Date
QSF487 Rev: 1/26/2016

Property Address:*

Type of Warranty Issued (if Known):

Project Number listed on Warranty*

Person to Contact:

Name:*

Phone Number:*

Email Address:*

This is verification that the owner listed below is the legal owner of the above listed property.

Building Owner Verification

Name:*

Address:*

Phone Number:*

Email Address:*

This is verification that the below listed firm is the property agent for this property listed above and is authorized to make decisions for the above referenced owner.

Building Management: (if any)

Contact Name

Management Name:

Address:

Phone Number:*

Email Address:*

Date of First Occurance:*

Location and Description of Complaint:*

Name of Person completing this form and contact information if different from above.*

Disclaimer: Submission of this form does not constitute approval or acceptance of this complaint for warranty.

KEMPER SYSTEM AMERICA, Inc.
1200 North America Drive
West Seneca, NY 14224

warranty@kempersystem.com