Who is Submitting this form? (required)
End UserTechnician - For End UserStore - for End UserStore - Floor Model

Attach Purchase Receipt (must include date) (required) (5 MB Limit)

Serial Number (required)

Chair Model Number (required)

Chair Color (required)

Detailed Description / Error Code (required)

Full Name (End User) (required)

Email (End User) (required)

Phone Number (end user) (best Contact) (required)

Postal code (End User)(required)

Date Purchased (required)

Store Purchased at (required)

Attach Pictures

Pictures (optional) (Max 6 pictures, 3 MB per file limit)