Customer Type (required):

Please SelectHome OwnerService Contractor

Customer Information:

Email (required)

Confirm Email (required)

Address Line 1 (required)

Address Line 2

State (required) States

County (required) Counties

City (required) Cities

Zip Code (required) Zip Code

Phone

Cell

Fax

Unit Information:

Serial Number of failed unit (required)

Model Number (required)

WCN (required)

Product Type (required) Please SelectCommercialResidential ElectricResidential GasTankless Gas

Date of Service was performed (required)

Service Technician Information

Company Name

Company Phone (enter only 10 digit number)

Representative Name

Description of work done

Reimbursement Information

Comments/Notes

Part Cost

Labor Cost

Additional Cost

Invoice Attachment (required) (Max file size: 5MB, Acceptable file types: pdf, jpg, png)

Proof of Purchase (Max file size: 5MB, Acceptable file types: pdf, jpg, png)

Additional Attachment (Max file size: 5MB, Acceptable file types: pdf, jpg, png)

By submitting this form, you agree to opt-in and receive communications from Rheem. In connection with your providing me with your personal information, we must advise you that information about Rheem’s practices regarding your personal information is located in Rheem's Privacy Notice located here.