A : Dealer information

Dealer *

Person in Charge

Reception Date

the date you submit to us

B : Purchase Information

Purchase Date

the date your costumer buy

Article Number

Product name

Color

Size

21-23cm (SS)
23-25cm (S)
25-27cm (M)
27-29cm (L)
29-31cm (XL)

C : Customer Information

M/W

Actual size of foot(cm)

Usage Count

Usage Distance(km)

Place of use(mainly)

D : Claim Information

Describe the issue *

Product / Claim Picture *

Please change picture name into : Thailand : THA-000 Malaysia: MLY-000 Hongkong: HKG-000 Taiwan: TWN-000 Singapore: SGN-000 Indonesia: IDN-000 Example: HKG-001 or HKG-002 (allow multiple)

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Warranty Claim Form

A : Dealer information

B : Purchase Information

C : Customer Information

D : Claim Information

Thanks for getting in touch!

Thanks for getting in touch!

Patagonia 修理代