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

mm/dd/yyyy

Exterior Site Conditions

Landscaping Complete

Yes

Waterfront

Yes

Gutters

Yes

Downspouts

Yes

Water Directed Away from Foundation

Yes

Interior Site Conditions

Inside Temperature

Humidity

Air Condition

Yes

Large Windows

Yes

Tinted Windows

Yes

Shades or Drapes

Yes

Dehumidifier

Yes

Dehumidifier Operational

Yes

Humidifier

Yes

Humidifier Operational

Yes

HVAC Type

Gas

Electric

Wood Stove

Yes

Air

Ducts Under Floor

Yes

HVAC on Before Installation

Yes

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

Joist Spacing

Damp Walls

Yes

Paint Peeling

Yes

Rusty Nails

Yes

Sump Pump

Yes

Operational

Yes

Dehumidifier

Yes

Operational

Yes

Crawl Space

Yes

Poly Cover

Yes

Cross Ventilation(Minimum 1.5% of Crawl Space Are)

Yes

Subfloor

Thickness

Flat 3/16" in 10'

Yes

Moisture Percentage

Underlayment Used

Yes

How Applied

Fastening Methods

Mechanical Type

Maintenance

Products Used

How Applied (Maintenance)

Claim Details

Consumer Claim

Desired Solution

Desired Solution Comments

Additional Attachments

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