Kohler Pump Repair App

3680 N. 126th St.
Brookfield, WI 53005
262.252.1600
Fax: 262.252.1616
Toll Free: 877.268.3700

Concerning the Kohler pump repair process if you decide to continue with our company, we would need the following:

PLEASE DO NOT SEND IN THE PUMP BEFORE YOU HAVE SUBMITTED THIS FORM. ONCE THIS IS RECEIVED WE WILL SEND YOU THE PACKAGING MATERIAL FOR THE PUMP.

Company or Individual's Name:

Contact Email:

Primary Phone:

Address:

City:

State: State is required.

Zip Code: Zip is required and numbers only.

Address:

City:

State:

Zip Code:

Pump Model Number:

Horse Power:

Symptoms of the Pump (details please):

Name as it appears on card:

Card Number: Credit card number is required.

Expiration date: Expiration date required.

CCV Code:^{(located on the back or front for Master Cards)}