Installed Claim Form

Please fill out the installed claim form below.

T&A Rep Email

Claim Submitter's Email

T&A Representative

Date

Retailer Name

Phone Number

Contact

Street Address

City

State

Zip Code

T&A Invoice Number

T&A Reference Number

Consumer Name

Consumer Phone

Consumer Address

City

State

Zip Code

Please provide a copy of your consumer inoice and labor bill.

Claim Submitted By

Has the dealer been on-site to review this claim?

Yes No Unsure

Product Name/Description

SKU

Date Purchased (Customer)

SY/SF Purchased

Date Issue Was Noticed By Consumer

Date Complaint Was Reported

Date Installed

Quantity Installed

Quantity Involved in Complaint

Rooms Installed

Estimated Labor to Resolve

Total # Of Cartons

# Of Cartons Opened

# Of Cartons Installed

Acclimation

Yes No

Acclimation Period

Moisture Reading Of Wood Prior To Install

Installed By

Retailer Consumer Consumer Contracted Installer

Installer Name

Installer Phone

Subfloor

Ply-Wood Concrete OSB Other

Type of Grade

On Grade Below Grade Grade Above Grade

Installation Method

Glue Float Staple Nail

Pad/Underlayment Used

Staple/Nail Size

Adhesive Used

Cleaning Method & Products Used

Cleaning Frequency

Describe the Issue

What is needed to resolve the issue?

Please submit photos and/or other evidence that substantiate this claim.

6821 S 216th Street
Kent, Washington 98032
United States

[email protected]
1.800.562.2857
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