Online Claim Submission
Online Claim Submission

Disclaimer: This form is only for US customers, if you experience any issues, please contact Billing@Rheem.com

    Customer Type (required):

    Customer Information:

    First Name (required)

    Last Name (required)

    Company Name (required)

    EIN (Employee Identification Number) (required)

    Email (required)

    Confirm Email (required)

    Address Line 1 (required)

    Address Line 2

    State (required)

    County (required)

    City (required)

    Zip Code (required)

    Phone

    Cell

    Fax

    Unit Information:

    Serial Number of failed unit (required)

    Model Number (required)

    WCN (required)

    Product Type (required)

    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)

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

    Current W9 (required) (Max file size: 5MB, Acceptable file types: pdf, jpg, png)

    Unit Label (Max file size: 5MB, Acceptable file types: pdf, jpg, png)

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

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