Service Request Form revised

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Service Request

"*" indicates required fields

First Name*

Last Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Mobile Phone*

Store Name*

Serial Number*

Chair Model Number*

Chair Color*

Date of Purchase*

MM slash DD slash YYYY

Do you have an active warranty?*

Please Upload Proof of Purchase*

Max. file size: 512 MB.

Attach Photos or Videos

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB.

Detailed Description / Error Code

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