Tarkett Claim Form Tarkett Created By Type of Complaint Complaint from Customer Credit/Refund Requested Reference Number(s) Description of Complaint Suggested Solution Date Filed: Form Completed By: Account Executive: Job Site and Product Information Claim Type: Commercial ResilientResidential ResilientSoft Surface Material Type: AdhesiveBroadloomCarpet BaseCarpet TileFiberFloorHEHOLaminateLILVTPowerBondResilientFeltRubber Base (TSB)Rubber SheetRubber Stair TreadRubber TileSVTVCTVETVinylVinyl Stair Tread Invoiced Customer: Part Number Description: Invoiced Customer Contact/Phone #: Invoiced Customer Email: Item Sku: Shade/Dyelot: Contractor Name: Batch: Address: Tarkett Invoice Number: City/State/Prov: Tarkett Order Number: Zip/Postal Code: Customer PO Number: Contractor Contact Name/Phone #: Installation Date: Contractor Contact Email Address: Completion Date: Job Site/End User: Address: City/State/Prov: Zip/Postal Code: End User Contact Name/Phone #: End User Contact Email Address: Problem Description / Comments Material Information Material Installed (QTY): Unit of Measure: BoxEachLinear FeetSquare FeetSquare MetersSquare Yards (duplicate for the second Unit of Measure) Material Defective (QTY): Unit of Measure: BoxEachLinear FeetSquare FeetSquare MetersSquare Yards (duplicate for the second Unit of Measure) Labor Amount Requested: Defect Found: Before InstallationDuring InstallationAfter Installation Misc. Amount Requested: Installed By: ContractorSub ContractorEnd User Installation Information Subfloor Grade: Above GradeOn GradeBelow GradeCombinationUnknown Type of Substrate: ConcreteExisting FloorcoveringDouble Wood Const.Single Wood Const.Unknown Substrate Porosity: PorousNon-PorousUnknown Status of Substrate: NewPrimedBareSelf - LeveledSkim CoatExisting LVTExisting VCTExisting SVMExisting CarpetExisting SheetUnknown Moisture Test Type (Prior to Install): RH TestCalcium ChlorideUnknown Installation Type: Full Spread GlueGlueless/FloatingPreimeter BondQS/RS Backing (Factory Applied)Unknown Material Acclimated: YesNoUnknown Results of Moisture Test: HVAC: YesNoUnknown Acclimation Time: 4 Hours8 Hours12 Hours16 Hours20 Hours24 Hours24 Hours +Unknown Adhesive Used (Resilient/Soft): 100 Clear Thin Spread901 SpraySmart905 Releasable906 Conductive925 Resilient Flooring926 Vinyl Flooring946 Contact959 Resilient Flooring960 Wall Base965 Flooring and Tread975 Two-Part986 Terra-Turf996 Two-Party EpoxyQBOND-ONERollSmartRS Backing (Factory Applied)B-19 BroadloomC-12E(FlexAire)C-14E(ER3)C-16E (PowerBond Cushion/MedFloor)C-350 Pressure SensitiveC-EX Premium ContactC-TR (ER3)Tarkett TapePower TapeCenti 6000Centi 2000 EPCenti 2001 Wet SetOther (Non-Tarkett) Temperature: "Non-Tarkett" Adhesive Used (Name): Application Method: TrowelRolledSprayUnknown Primer Used (Soft): C-36E PrimerC-56 PrimerUnknownOther Trowel / Nap Size: 1/32x1/16x1/32 U Notch1/16x1/16x1/16 SQ Notch1/16x1/16x1/16 V Notch1/8x1/16x1/8 V Notch3/32x3/32x3/32 V Notch1/8x1/8x1/8 SQ Notch1/8x1/8x1/8 V Notch3/8Nap Paint RollerShort Nap Paint Roller Cleaner Used: BuckeyeCertified Green ProductsDiverseySpartan ChemicalXL NorthHillyardCenti CleanSureShine CleanerSyon 5Other If "Other" Cleaner" "Please Name: Seam Sealer Used: 54 Seam WeldC-XL Seam SealerCWL Cold WeldDT-65DT-25Heat WeldUnknown Machine / Method used: WetCleanSoftWhite Cloth (Wall Base)Windsor Industires iCapsol Mini (Soft)XL North/Grab Carpet Cleaning System Xleator(Soft)Carpet Cleaner America's Dri-Star & Renovator (Soft)NA Cleaing Equipment Duplex Hydrowasher (Soft)Single Disc Rotary Machine (175-350RPM, 3M 5100 Red Pad) (Resilient)Single Disc Rotary Machine(175-350RPM, 16-24 gauge nylon bristle brush)(Resilient)Deck Brush attached to handle (Resilient and Stair Treads)Auto Scrubber (175-350RPM, 16-24 guage nylon bristle brush) (Resilient); Sponge Mop and Bristle (Resilient)String Mop and Bucket (Resilient)Unknown Request Outcome * Please include representative photos with the filing of the claim form * If labor is requested, please include a copy of an itemized labor bill with the submission of this form. Add Attachment Please leave this field be