Product Claim

Inspection Details:

Date of Complaint *

Newflor Area Manager

Inspection Date *

Retailer Details:

Account Name

Customer Contact Number *

Store Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Unique ID

Product Code

Quantity Supplied (Lm)

Quantity Involved in Complaint (Lm)

Newflor Invoice Number

Date Supplied *

Retail Value of Installation

Additional Details

Problem & Details:

Complainant Name

Complainant Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Nature of Complaint

Location of Product in Building

Sub-floor (Specify Type)

Adhesive Used

Photos Supplied?

Yes
No

Sample Supplied?

Yes
No

Opinion as to Cause of Problem

Newflor Area Manager's Recommendations

Actions:

Credit Approved?

Yes
No

Credit Value

Credit Note Number

Credit Note Date

Product to be Returned?

Yes
No

Other:

Additional Information

Photo 1

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Photo 2

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