Material Partially or Not Installed Claim Form

Claim Form Confirmation
A copy of this finished form will be sent to the following emails for your records.
T&A Rep Email*
Claim Submitter's Email*
Dealer Information
T&A Representative
Has the Dealer been onsite to review the claim?
- Yes
- No
Dealer Name
Dealer Contact Name
Dealer Contact Phone
Dealer Contact Email
Dealer Address
Street Address Address Line 2 City State ZIP Code
CONSUMER INFORMATION
Consumer/Job Site Information
Consumer/Job Site Name
Consumer/Job Site Phone
Consumer/Job Site Address
Street Address Address Line 2 City State ZIP Code
PRODUCT INFORMATION
Product Name
Product SKU
Reference #
Invoice #
Inspection Required
- Yes
- No
CLAIM INFORMATION
Date reported
MM slash DD slash YYYY
Submitted By:
Describe the issue
Please attach any evidence to support your claim here (documents, pics, 30-second videos, etc.)
Your file has finished uploading when a red "x" appears next to its name. Then your claim will be ready to submit.
Drop files here or

Accepted file types: jpeg, gif, png, tiff, bmp, pdf, jpg, Max. file size: 50 MB, Max. files: 10.
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Phone
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*Please allow 24-48 hours for a response. Thank you for your patience.

Claim Form Confirmation