kanaflex-claim-form HOME > Claim Kanaflex Claim Form Please enter your contact information to Start a Claim Please enable JavaScript in your browser to complete this form.Name *Email *Contact Phone *Company *CityWho is your Kanaflex Rep?Pick oneBrad PowellPeter BishopMike HambletonFrank DestroEric LiebgottJohn McCulloughBruce McintoshMike MorganRich MorganGary RookerOther (Include in Other Notes)Purchase Order # (REQUIRED): *What is the hose model? (110 CL, Kanaline SR, 180AR, etc )Hose DiameterHose Length (Coil or Stick)Total Hose FootageEnd User Name:End User Address:Nature of the claim?Duration of time the hose was in use:Application:Is this a New ApplicationYesNoWhat was the hose connected to:Type of material was going through the hose:Maximum pressure or maximum vacuum pressure used:Temperature range in this application:Hose Lot Number VXXX or CXXX):Other NotesSubmit Catalog Download