Material Partially or Not Installed Claim form

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*
Dealer Information
Has the Dealer been onsite to review the claim?*
- Yes
- No
Dealer Name*
Dealer Contact Name*
Dealer Contact Phone*
Dealer Contact Email*
Dealer Address*
Street Address Address Line 2 City State ZIP Code
CONSUMER INFORMATION
Consumer/Job Site Information*
Consumer/Job Site Name*
Consumer/Job Site Phone*
Consumer/Job Site Address*
Street Address Address Line 2 City State ZIP Code
PRODUCT INFORMATION
Product Name*
Product SKU*
Reference #*
Invoice #*
Inspection Required*
- Yes
- No
CLAIM INFORMATION
Date reported*
Date Format: MM slash DD slash YYYY
Submitted By:*
Describe the issue*
Please attach any evidence to support your claim here (documents, pics, 30-second videos, etc.)
Your file has finished uploading when a red "x" appears next to its name. Then your claim will be ready to submit.
Drop files here or
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Name
This field is for validation purposes and should be left unchanged.

*Please allow 24-48 hours for a response. Thank you for your patience.

Claim Form Submission