Retailer Warranty Claim Form

PLEASE NOTE: Registration of this claim depends on the provision of a completed claim form and clearly labeled digital photo showing the nature of the complaint. Finalising the claim includes the return of Product, Sample of Faulty product or any other requirement/proof of claim necessary to complete the claim. If circumstances call for an extension on this claim, this form is to be signed by a representative of Belgotex International Floors Ltd, including reasons and expected completion date.

NOTE: INCORRECT OR MISSING INFORMATION WILL DELAY THIS CLAIM FROM PROGRESSING

Type of Claim*

RETAILER DETAILS:

Company name*

Street address*

Street address of the retailer

City*

First name*

Last name*

Email *

Phone Number*

PRODUCT INFORMATION:

Date of complaint*

Day-Month-Year

Has the retailer/installer been back to site?*

Complaint examined by

Date examined

Day-Month-Year

Faulty Product*

Product name, colour, etc.

Product/Pattern Number*

Fault Description*

Faulty area meterage*

Total job meterage*

INITIAL ORDER INFORMATION:

Order Date*

Day-Month-Year

Purchase Order Details*

Invoice Number*

JOB DETAILS:

Customer Details*

Name, contact details, etc.

Address of Property with Warranty Claim*

Date of install

Day-Month-Year

Method of installation

Underlay used

(If applicable)

Adhesive used

(If applicable)

Type of floor

(e.g. concrete, timber, etc)

Name of vacuum cleaner

(If applicable)

Head type

Product used to clean floor

Professional cleaning

Yes

What type/how many times?

Images/Files*

You can attach multiple files to support your claim including images, moisture test results, invoices, etc.

Faulty Product

• Digital photos must be taken at first inspection and attached to this online form.
• We require a full job plan showing the fault areas.
• All complaints must be advised to Belgotex International (ideally within 48 hours).
• A completed claim form must be submitted online using this form.
• A sample or photos (including full room shots) showing the nature of the fault will
need to be provided to Belgotex before the claim can be registered.
• Uplifted product must be returned to Belgotex if requested. Failure to do so will result
in the claim being declined.

Product Returns

• No product is to be returned without prior notification.
• We will make necessary freight arrangements and advise accordingly.
• A return fee and freight charges will apply where the return is not due to a Belgotex
International error.
• Returns not properly packed will not be accepted by Belgotex International and will not
be credited. (All sheet products must be returned in a rolled form, including a core,
with the fault or damage clearly marked).

It is understood that inspection by the supplier will only be made with a representative of the Retailer present and that any prior commitment by the Retailer cannot be recognised by the Manufacturer.

***Before your claim is approved please make sure you submit all costs related to the claim. Once your claim has been approved, we will not accept any additional costs ***

I accept that the information provided is true and correct and that I agree to the terms stated on this form. Failure to provide sufficient or false information may result in the claim being declined.*