First Name
Last Name
Phone Number
Email
Address
City
Post Code
Warranty registration number or previous claim reference
Product code
Date of Purchase
Reason for claim
Comments
I agree to provide my personal information to Leviton for use in accordance with its
Privacy Policy
. *
For California residents only. In accordance with the CCPA, I understand that I may be providing the following Categories of Personal Information (as defined in the CCPA) to Leviton by completing this form: Identifiers, Commercial Information, and Internet or other similar network activity, for the purpose of fullfilling my request.
By submitting this form, I certify that the information I have provided is true.
I have read and understand the Warranty
Terms and Conditions
. *
I have read and understand Leviton's
Privacy Policy
. *