Material Service Questionnaire

How to complete
Before you begin, please review the form and gather all information and photos you plan to include. For your security, submissions time out after 45 minutes. Do not refresh or navigate away during submission. Photo uploads are required in the Uploads section. Max 10 images, 8 MB each.

1. Owner’s Information

Owner's Name

E-Mail Address

Street

City

State

Zip Code

Phone #s

2. Jobsite

same as owner information

Street

City

State

Zip Code

Phone #s

3. Material Details

Product Type

Color

Squares/Amount Affected

Total Product on Job

From whom was the material purchased?

Who applied the material?

Who owned the building at the time of installation?

Exact date of installation

Was material damaged in any way prior to installation?

Yes No

Was material satisfactory at the time of installation?

Yes No

Was workmanship satisfactory at the time of installation?

Yes No

Describe condition of job now due to condition of material

Describe condition of job now due to workmanship

Was building ever subjected to flood, tornado, cyclone, hailstorm, fire, paint, insecticide, fuel oil, gas, fertilizer, spray or fumes?

Yes No

How often has the material been cleaned?

What type of cleaner was used?

Signature (type your name)

Date

Uploads

The size of all files combined should not exceed 16 MB in total.

Upload Warranty file (JPG, PNG, or PDF)

Upload picture of building full size (JPG or PNG)

Upload picture of wall where issue is occurring (JPG or PNG)

Upload picture(s) of issue clearly shown (JPG or PNG)

At least one required.

By submitting, you confirm the information is accurate and consent to be contacted about this questionnaire.