Claim Submission Form

Claim request form

Please review the form fields carefully and submit. You will be able to attach images and supporting documents to help us process your claim in a timely fashion.

Contact Details

Full Name

Email address

Phone Number

Account Information

Account Number

Account Name

Address Line 1

Address Line 2

City

State

Zip

Country

Job Site Address

Please fill if different from Account Address

Is Job Site address different?

Address Line 1

Address Line 2

City

State

Zip

Country

Purchasing Details

Sourcing Branch

Salesperson Name

Date of Purchase

Order Number

Invoice Number

Product Name

Part Number

Was this product purchased on behalf of another entity? (e.g. Home builder, developer, etc.) If yes, please list entity in box below.

Additional Job Site Information

Thin Set Used

Grout Used

Upload supporting documents

Claim request cannot be submitted without attachment
Photo of product concern
Photo of carton label
Photo of original order acknowledgement (if available)
Photo of room where there is a concern (if applicable)
Photo of setting materials used (bag of thin-set and/or grout)
Any additional photos you choose to share

I agree to the terms and conditions.