TODAY146S DATE FILLED OUT BY Your and Your Company146s name CONSUMER146S NAME ID: 837244
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1 MANUFACTURER CLAIM FORM TODAY’S DAT
MANUFACTURER CLAIM FORM TODAY’S DATE: _________________________________________FILLED OUT BY: _______________________________________ (Your and Your Company’s name) CONSUMER’S NAME: ___________________________________RETAILERS ________________________________________ NAME/DISTRIBUTOR: ADDRESS: ______________________________________________ADDRESS: _____________________________________________ _________________________________________________________ _______________________________________________________ PHONE: ________________________________________________PHONE: _______________________________________________ CONTACT NAME: _____________________________________ (Distributor Reprensentative if Applicable) PRODUCT NAME: _____________________________________________________________________________________________________ QUANTITY: ____________________________________________ IN (ROOMS): __________________________________________________________________________________________________________ DESCRIBE ISSUE OF CONCERN: Has the problem gotten worse or has it stabilized? _____________________________________________________________________ Disclaimer: In most cases, Niko’s Import and Export, LLC will arrange at our expense for a N.W.F.A. (National Wood Consumer to arrange for scheduling of inspection. The time necessary to complete a claim varies based on the Inspector’s and Consumer’s availability. job. An unauthorized �oor replacement or repair does not place any burden on the manufacturer. 51015 Regency Center Drive Macomb Twp. MI 48042 fax: 586-781-9009 www.nikosimportexport.com