Submit Claim

Claim Form

Some description about this section

Claim Type

Invoice #

Purchase Order #

Please include your sales rep information

First Name

Last Name

Some description about this section

Company Name

First Name

Last Name

Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Some description about this section

Flooring

Color	System	Size	Thickness	Wear Layer	Quantity

Baseboard

Profile	Color	Quantity

Metal Trim

Profile	Color	Quantity

Moldings

Profile	Color	Quantity

Moldings

Product	Color	Quantity

Underlayment

Product	Quantity

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Description of problem

File Upload

Choose File