CLAIM INFORMATION
Location of Warranty Claim (if other than Claimant Address):
Product involved (check all that apply):
__ Universal Sealer __ Universal Primer
__ Starting Line Topcoat __ TopLine Topcoat
__ Formula One Armor __ Formula One Shield
__ Professional Primer __ Professional Shield
__ Professional High Build Sealer
__ Professional Adhesion Primer __ Professional Armor
__ Professional Shield
Please indicate sheen of Shield/Topcoat applied: __ Matte/Commercial __ Satin __ Gloss
Room(s) with warranty issue: ______________________________________________________
Size (square feet): __________________________
Date coating was applied: ____________________
What type of application? (Circle One)
1-New Floor 2-ReSand and Coat 3-Screen and Re-Coat
Detailed Description of problem: __________________________________________________________
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