Taylor Adhesives Claim Form Taylor Adhesives Product Installation Complaint Record Authorized Representative Territory Date Completed Claim Number Date Received SECTION 1 W.F. TAYLOR Distributor Company Name Contact Person Phone Number E-mail Address Fax Number Address City State Zip Code SECTION 2 INSTALLATION Contractor's Name CONTRACTOR'S Company Name Phone Number E-mail Address Fax Number CFI Status CFI Number CFI Expiration date Address City State Zip Code SECTION 3 Job Name Phone Number Date of installation Location (Street Address, City, and State) Type of building (school, hospital, office, etc.) Dimensions of flooring (width, thickness, length & gauge) Flooring manufacturer Flooring product name Size of job (square feet) SECTION 4 List every person present at the inspection: What is the problem and how long after installation was the problem first noticed?: have any possible sources of moisture vapor or water been identified? If so, describe.: SECTION 5 Substrate Age Years Months Substrate Type (concrete, plywood, particle board, etc.): Grade: OnAboveBelow Moisture Tested: YesNo Moisture test manufacturer and type: PH Alkalinity Tested: YesNo Porosity checked: YesNo Patched and/or leveled: YesNo Patch/Level compound manufacturer: Patch/Level Product: Surface treated: YesNo Type of treatment (sealer, removal of old product etc.): SECTION 6 Conditions at time of installation Temperature Humidity Doors and Windows Shut YesNo HVAC Running YesNo Flooring acclimated to job site YesNo How Long? Adhesive acclimated to job site YesNo How Long? Taylor adhesive products used Batch numbers and gallons used of each Trowel Size/nothc (width x depth x apart; u, v, sq. flat, etc.) How much open time of adhesive allowed Flooring Rolled YesNo Roller weight Room for expansion YesNo How Much? Trafic during curing YesNo How Much? Ventilation method during curing Describe Maintenance method and frequency SECTION 7 is this complaint related to adhesive bond failure? Include as many of the following as possible: copies of the invoices for W. F. Taylor products and flooring product; test results (moisture vapor emissions, pH levels, etc.); sample section of the installation; photographs, and any correspondence between involved parties. Failure to send supporting evidence will delay resolution of the complaint. Please leave this field be
