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Contact Details
First Name
Last Name
Phone Number
Email
Current Address of Product
Street Address 1
Street Address 2
City
State
Postcode
Country
Please select...
Australia
Your Claim
Product(s) purchased from
Please select...
Living Edge Showroom
Living Edge Website
Living Edge Dealer
Living Edge Commercial Order
Proof of Purchase #
Max 20 Characters
Please attach a copy of your original Proof of Purchase
Product(s) on Claim
Please list the Product(s) for this claim
x
Qty of Product(s) on Claim
Please list the quantity of the Product(s) for this claim.
x
Description of Issue
Please be specific: What/where/when the issus is occuring. Eg. Broken castor on chair leg.
x
Upload an image of the manufacturers label (10MB Limit)
Please attach images to support your claim
Upload image/video of issue.
(10MB Limit)
Upload image/video of issue. (10MB)
x
Upload image/video
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Upload image/video
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Upload image/video
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Office Use Only
Living Edge Staff ID
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