Mactac | Claims Submission

* Required

Contact Information

Contact Name *

Company Name *

Phone *

Email *

Claim Information

Mactac Order Number

Mactac Invoice Number

Customer Purchase Order

Mactac Part Number *

Quantity / UOM

Size

Lot No

Trace ID

Product Defect *

Brief Description *

Information Only? *

Yes No

Dollars Requested $ *

Corrective Action? *

Yes No

Include Images

Accepted filetypes: .gif, .jpeg, .jpg, .pdf, .png

Thank you for submitting your claim. Our team will be in contact with you within two business days.