Flooring Claim Form

Flooring Claim Form | Hardwood

Please complete the below form in detail in order to process the claim in the most efficient manner. Thanks!

Palmer-Donavin Outside Sales Representative

Order Information

Manufacturer*

Product Item Number*

Run Number (If Available)

Palmer-Donavin Invoice Number*

Dealer Information

Dealer Name*

Dealer First and Last Name*

Email Address*

Phone Number*

Consumer Information

First and Last Name*

Address*

City*

State*

Zip*

Phone Number*

Flooring Information

Type of Construction*

Residential

Commercial

Type of Install*

New Build

Remodel

Flooring Installation*

On Grade

Above Grade

Below Grade

Acclimation Period*

How long was the flooring in the house before installation

Moisture Percentage

Minimum of 10 different readings from 10 different areas are needed.

Date Installed*

Date Issue Noticed*

Exterior Site Conditions

Landscaping Complete

Yes

No

Waterfront

Yes

No

Gutters

Yes

No

Downspouts

Yes

No

Water Directed Away from Foundation

Yes

No

Interior Site Conditions

Inside Temperature

Humidity

Air Condition

Yes

No

Large Windows

Yes

No

Tinted Windows

Yes

No

Shades or Drapes

Yes

No

Dehumidifier

Yes

No

Dehumidifier Operational

Yes

No

Humidifier

Yes

No

Humidifier Operational

Yes

No

HVAC Type

Gas

Electric

Wood Stove

Yes

No

Air

Select

Ducts Under Floor

Yes

No

HVAC on Before Installation

Yes

No

Length of Time HVAC was on

If Yes, was selected above, please enter the time HVAC was on before installation.

Basement and/or Crawl Space Conditions

Temperature

Humidity

Finished Space

Yes

No

Joist Spacing

Damp Walls

Yes

No

Paint Peeling

Yes

No

Rusty Nails

Yes

No

Sump Pump

Yes

No

Operational

Yes

No

Dehumidifier

Yes

No

Operational

Yes

No

Crawl Space

Yes

No

Poly Cover

Yes

No

Cross Ventilation(Minimum 1.5% of Crawl Space Are)

Yes

No

Subfloor

Select

Thickness

Flat 3/16" in 10'

Yes

No

Moisture Percentage

Underlayment Used

Yes

No

How Applied

Fastening Methods

Mechanical Type

Select

Maintenance

Products Used*

How Applied (Maintenance)*

Claim Details

Consumer Claim*

Desired Solution*

Select or enter value

Desired Solution Comments*

Additional Attachments*

Drag and drop files here or

Send me a copy of my responses

Privacy Notice|Report Abuse