Next Floor Claim Form Next Floor Created By Type of Complaint Complaint from Customer Credit/Refund Requested Reference Number(s) Description of Complaint Suggested Solution Center date Area Dealer Address City State ZIP Contact at Dealer Dealer Phone End User City State ZIP Contact at End User End User Phone Installation Date Professionally Installed YesNo Distributor Claim No. Distributor Invoice No. SY Affected (Carpet Tile) SF Affected (LVT) # of cartoons Style and Color Name & Number DYE LOT DESCRIBE USE AREA Office Description of Problem Material Labor YesNo Attach copies of distributing invoices, Nex Floor invoice, and photograph showing defect Please leave this field be