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*

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

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..)