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Please have a copy of your original invoice with you when completing this form
Invoice Number: *
Any Previous Claim Numbers:
Date of Purchase:  *  
What type of store did you purchase it from?
Harvey Norman
Domayne
Joyce Mayne
Store Suburb/Location of Store: *
Brand: *
Product Description: *
Model Number:
You must enter at least one of "Model Number" and "Product Code"
Product Code:
Serial Number: *
How much extended warranty did you purchase?
12 Months
24 Months
36 Months
48 Months
YOUR CONTACT DETAILS
Full name on invoice: *
Best contact phone number: *
Alternative Number:
Email:
Address:  *
This must be a physical address, not a post office box.
FAULT DETAILS
What type of product do you have?
Notebook
Desktop
Television
Washing Machine/Dishwasher
Refrigerator/Freezer
Other

What fault is your unit experiencing?  *
(please provide a generic description of the faults to your unit)

Extended Warranty is limited to faults of an electrical, electronic or mechanical nature. As such, faults caused by failure to perform general maintenance and cleaning, wear & tear, physical damage or the need to replace cosumable items are not covered. Where there is no fault found or the fault is not covered by our warranty, all costs including quote fees are payable by the customer.

* Indicates a mandatory field.