Claims Form
Full Name
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First Name
Last Name
Phone Number
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Email Address
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example@example.com
Property Address
Street Address
Street Address Line 2
City
State
Zip Code
Type of Flooring
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Please Select
Carpet
Hardwood
Laminate
Sheet Vinyl
Luxury Vinyl Plank
Tile
Issue of Concern (Carpet)
Please Select
Seam Separation
Wrinkling
Stain
Crushing
Fading
Texture Loss
Other
Issue of Concern (Hardwood)
Please Select
Cupping
Lifting
Plank Separation
Edge Damage or Chipping
Discoloration
Scratching
Other
Issue of Concern (Laminate)
Please Select
Cupping
Lifting
Plank Separation
Edge Damage or Chipping
Scratching
Other
Issue of Concern (Sheet Vinyl)
Please Select
Bubbling
Discoloration
Other
Issue of Concern (Luxury Vinyl Plank)
Please Select
Cupping
Lifting
Plank Separation
Edge Damage or Chipping
Discoloration
Scratching
Other
Issue of Concern (Tile)
Please Select
Bond Loss
Tile Cracking
Grout Cracking
Other
Please explain the issue(s)
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