Bishop Distributing Flooring Claim Form Download Form (PDF) "*" indicates required fields RETAIL STORE INFORMATIONDate Submitted:* Store Name: Account #:* Contact Name:* Phone:Email:* Address: Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CUSTOMER INFORMATION (If Applicable)Owner's Name: Phone:Address: Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PRODUCT INFORMATIONInvoice #:* item #: Quantity Purchased:* Item Description: CLAIM DETAILSWhen was the item issue noticed?: How much of the floor is affected?: Description of the issue:*Has anyone been to the jobsite to review?: Yes No If so, findings: Have any steps been taken to resolve the issue?: Recommendation for resolution: (Board repair, full replacement, replacement material only, etc.) INSTALLATION DETAILSIs the product installed?: Yes No If so, when was it installed?: Where is the product installed?: (i.e. Hallway, bathroom, basement, etc.) How was the product installed?: (i.e. Floating, direct glue, etc.) Who installed the flooring?: (i.e. Retailer, contractor, consumer, etc.) Type of adhesive used: (If Applicable) Type of fasteners used: (If Applicable) Type of underlay used: (If Applicable) Type of subfloor: HVAC information type: Were moisture test performed on the product and/or substrate?: Yes No If so, what were the results?: MAINTENENCE INFORMATIONWhat products/methods have been used to clean the flooring and with what frequency?: FILESIn order for us to process your claim, the manufacturer requires:Labor Bill* Drop files here or Select files Max. file size: 128 MB. With grout, adhesive, underlayment, etc. listed. Should include quote for tear-out and replacement related labor.Photographs showing the entire room* Drop files here or Select files Max. file size: 128 MB. Photographs showing the issue* Drop files here or Select files Max. file size: 128 MB. Photographs showing the use of moldings / transitions Drop files here or Select files Max. file size: 128 MB.
