Gross Automation logo

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.


Customer Billing Address:

State is required.
Zip is required and numbers only.

Customer Shipping Address (if different than billing):


Pump Information:

Credit Card Information:

Credit card number is required.
Expiration date required.