Midway Contact form - Warranty Claim

Dealer/Contractor Contact Information: identifies the person that determined the problem, as described, is the result of material or a manufacturing defect.

Customer Contact Information: identifies the person, a phone number, and most importantly, the best time to call to establish a schedule for the resolution of the claim.
Dealer Name*
Order Number*
Job Name*
Date*

MonthDayYear
Date
Please fill in all required fields
Dealer/Contractor Information
Dealer/Contractor
Primary Contact
Phone Number
Please enter a valid phone number.
Order / Invoice #
Installation Date

MonthDayYear
Date
Contact Email
example@example.com
Customer Contact Information
Customer Name
Address
City, State, Zip Code:
Primary Phone
Please enter a valid phone number.
Daytime Phone
Please enter a valid phone number.
Customer Email
example@example.com
Window Location in the Home
Describe the nature of the problem and or specific warranty part requirement. Pictures of the label with order number and pictures of the damage from the inside and outside are required. (Size, Left or Right from outside, Low-e, Tempered, Grids, ect..)
Please provide images below*

Cancelof
Should be Empty: