Material Partially Or Not Installed Claim Form

Please fill out the material partially or not installed claim form below.

Claim Form Submission
A copy of this finished form will be sent to the following emails for your records.
Pacmat Rep Email*
Claim Submitter's Email*
RETAILER INFORMATION
Has the Dealer been onsite to view the claim?
- Yes
- No
Dealer Name
Dealer Contact Name
Dealer Phone
Dealer Email
Retailer Address
Street Address Address Line 2 City State ZIP Code
CONSUMER INFORMATION
Consumer Name
Consumer Phone Number
Consumer Email
Consumer address
Street Address Address Line 2 City State ZIP Code
PRODUCT INFORMATION
Product Name
Product SKU
Reference #
Invoice #
CLAIM INFORMATION
Date reported
MM slash DD slash YYYY
Submitted By:
Inspection Requested
- Yes
- No
Describe Issue
Please upload photos or a short video (30 seconds or less) of your claim here:
Drop files here or

Max. file size: 20 MB, Max. files: 5.

Products