5 Year Horizontal Warranty (Section 3)

4456 S. Clifton, Wichita, KS 67216

(316) 522-9300/(800) 676-7346

stacy@watersealant.com
5 Year Horizontal Water Repellent Warranty Application (Section 3)

To be completed upon project completion
Project Name:
City:blanks, State: blank
Project Detail:
Was the entire project, listed in Section 1, treated? Yes No
If no, Describe the specific areas that weren't treated with Professional Water Sealant:
Application Information:
Professional Water Sealant Formulation to be used:PWS-5 (Regular) PWS-8 (Extra)
Product Batch #(s) (located on stick on label on product container)
Number of Gallons Used:
Square Footage of Area Treated for Water Repellent Protection:
Actual Coverage Rate (divide the number of sq ft treated by the number of gallons used): Type a label sq ft/gal
Application Date(s):

MonthDayYear
Date
Application Method:
Weather Conditions:
Distributor Name:

First NameLast Name
Distributor Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
After Application Testing

To be done 10-14 days after project completion
Testing Completed By:

Company NameName
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date of Rilem Testing:

MonthDayYear
Date
Type of Rilem Used - Tall or Short (Short for Block Only):
Project Manager Certification:

I certify that the information provided on this application is correct and that the product was applied in accordance with Professional Products of Kansas' Application Instructions.
Project Manager:

First NameLast Name
Signature
Form Submission
Submitted By:

First NameLast Name
Submitted On:

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Product purchase invoices must be submitted with this application

Attach here or email any additional info or questions to Stacy@watersealant.com
Purchase Invoices (or any additional added information)

Cancelof
Should be Empty:

5 Year Horizontal Water Repellent Warranty Application (Section 3)

Project Detail:

Application Information:

After Application Testing

Project Manager Certification:

Form Submission

Product purchase invoices must be submitted with this application