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Notice of Claim and Request for Independent Inspection

Date of this Notice:
required
Name:
required
Email Address:
strongly recommended, as we will keep you advised of the status via email
Date of Purchase:
required
Worldwide Invoice Number:
required
Date of Installation:
required
Place and Rooms of Installation:
required
Names of all present at the time of Installation:
required
Style or Item Number:
required
Detailed Description of Claim:
required
                
JPG Digital Photos Attached:
required
Yes       No
          JPG Photo One:
          JPG Photo Two:
          JPG Photo Three:
Phone Numbers Where You Can Be Reached During the Day:
required
This Notice is subject to all of the terms and conditions of the Worldwide Purchase Order and the Manufacturer's Warranty, if any, all of which are incorporated by this reference.

By submitting this Notice the Claimant is verifying under penalties of perjury that the information supplied is true, and that the description of the Claim is complete and does not omit any facts which tend to make it misleading. The submission of this Claim does not entitle the Claimant to relief until so determined by an Independent Inspector designated by Worldwide. Claimant agrees to cooperate with Worldwide to provide the Inspector with access and to be present and answer the Inspector's questions, if any.

 

       
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