Name:

Street:

Number:

Postal code:

City:

Telephone:

E-mail address:

Invoice number:

Add invoice (Max. 1 Mb – if more than 1 Mb then form will not be sent)
Upload here the invoice for a faster treatment of your guarantee claim

Date of damage of your flat-jack:

At which hour did your flat-jack burst?:

In which city/village and in which country did your flat-jack burst?:

Which part of your flat-jack was damaged/where does the air go out of your flat-jack:
- weld seam short side/ weld seam long side
- at valve shaft below/at valve upper side (valve cap leaks)
- damaged at the bottom side of the flat-jack
- Otherwise, that is:

Vehicle under which your flat-jack was placed:
- camper
- caravan
- folding caravan
- 4x4
- Otherwise, that is:

Brand and model of vehicle:

What was the ground material on the spot when your flat-jack was damaged:
- Grass or sand
- Red/black gravel or round stones
- Rock or river stones
- Street brick or asphalt
- Snow or ice
- Otherwise, that is:

Weather circumstances at damage moment of flat-jack:
- dry and sunny
- dry and cloudy
- rain
- hail
- snow
- Temperature in degrees Celsius:

How much pressure in bar was pumped into your flat-jack when it was damaged:

Height in cms of the inflated flat-jack at moment of damage:

Flat jack inflated with:
- bike pump
- foot pump
- mini-compressor
- compressor
- Otherwise, that is:

Did you use a protection mat or plate under your flat-jack to prevent damage, like:
- clean walk mat
- rubber mat
- coconut mat
- Carpet tile
- wooden plate
- metal plate
- Otherwise, that is:

What protection against direct sunlight at temperatures above 25 degrees Celsius did you use over your flat-jacks?

How many times did you use your flat-jack from new until the moment it was defect?

We would like to know the position of your vehicle’s tyre on the flat-jack, so we ask you to add a picture (Max. 1 Mb -if larger than 1 Mb the form will not be sent)
Please send a photo of the situation directly after the damaging of your flat-jack, which helps us process your guarantee claim faster.

By ticking this I declare:
- to having used the flat-jack always according to the instructions for use, before it was damaged.
- to have read the complete instructions for use in detail.