Certified PolyPro Company Name:
*
First Name
Last Name
Certified PolyPro Company Name:
*
Customer Name:
*
First Name
Last Name
Customer Company Name:
Customer Email:
*
Customer Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Customer Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Location of project if different than address above:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What product(s) were installed: (please mark all that apply)
*
C&S Porous
C&S Non-Porous
Custom Branding / Logos / Design
Bunker Liner
Not Sure
What color(s) Polylast was purchased?
*
Black
Brick Red
Bronze
Canyon
Irish Green
Sandy
Special Tan
Stormy
Custom
Purchase date:
*
-
Month
-
Day
Year
Date
Installation date:
*
-
Month
-
Day
Year
Date
Type of use:
*
Personal / Residential
Commercial
Golf Bunker Liner
Did you opt in to the Polylast Global Annual Maintenance Program:
*
Yes
No
Not Sure
Did you purchase an extended warranty:
*
Yes
No
Not Sure
Where was Polylast installed? For example, vet clinic, trailer, golf course, etc.
*
Vehicle Identification Number (VIN), if applicable:
Vehicle manufacturer, if applicable.
Square footage of the install:
*
Square footage of the area you would like repaired or replaced:
*
Brief description of the project: (please include place of install, custom color, how the product is used, etc.)
*
Detailed description the damage, including how and when it occurred:
*
Please upload at least 3 clear photos of the damaged area.
*
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Please upload a copy of your warranty:
*
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Please upload or attach a copy of your warranty dated and signed by both you and your installer.
Cancel
of
Please upload your proof of purchase:
*
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Please upload or attach a copy of your proof of purchase (invoice/receipt) and installation documents?
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Submitted by:
*
First Name
Last Name
Signature of submitter:
By submitting this form, I confirm the following: I have read and understood the Polylast Global Limited Warranty terms and conditions.I acknowledge the importance of using Certified PolyPro services for installation, maintenance, and repairs to ensure warranty validity. I understand that failure to adhere to the warranty terms, including maintenance requirements, may void my warranty.
Date submitted:
-
Month
-
Day
Year
Date
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