Application for MATERIAL & LABOR Warranty

Page 1

Page 2

Please complete both pages and be sure to click on the "SUBMIT" button at the bottom of the last page.

All fields with a red asterisk are required.

CONTACT INFORMATION

PROJECT

Enter name of project

If "Other" was selected above, enter the project type

Project Address

All fields must be completed.

Address 1

City

ZIP / Postal Code

State / Province

OWNER

Enter Owner Name

Owner Address

All fields must be completed.

Address 1

City

ZIP / Postal Code

State / Province

Owner Contact Name

Owner Contact Phone Number

INSTALLER

Enter Firm Name

Installer Address

All fields must be completed.

Address 1

City

ZIP / Postal Code

State / Province

Installer Contact Name

Installer Contact Phone Number

ARCHITECT / ENGINEER

Enter Firm Name

Architect / Engineer Address

All fields must be completed.

Address 1

City

ZIP / Postal Code

State / Province

Architect / Engineer Contact Name

Architect / Engineer Contact Phone Number

CONSULTANT

Enter Firm Name. If there was a consultant on this project, all fields must be completed. If no consultant, enter "N'A"

Consultant Address

If there was a consultant on this project, all fields must be completed.

Address 1

City

ZIP / Postal Code

State / Province

Consultant Contact Name

Consultant Contact Phone Number

GENERAL CONTRACTOR

Enter Firm Name

General Contractor Address

Address 1

City

ZIP / Postal Code

State / Province

General Contractor Contact Name

General Contractor Contact Phone Number

DISTRIBUTOR

Enter Firm Name

Distributor Address

Address 1

City

ZIP / Postal Code

State / Province

Distributor Contact Name

Distributor Contact Email

Distributor Contact Phone Number

Please complete both pages and be sure to click on the "SUBMIT" button at the bottom of the last page.

Please complete both pages and be sure to click on the "SUBMIT" button at the bottom of this page.

MEMBRANES & AMOUNTS OF MATERIALS USED

WATERPROOFING

ONLY Polyguard's Pre-Applied & Post-Applied Sheet Waterproofing Qualify for Material & Labor Warranties. The following membranes qualify: Underseal® Blindside™, Underseal® Underslab, Underseal® PRM™ and 650 Membrane.

Sheet-Applied Waterproofing: PRE-APPLIED

Product	Application Direction	Application Type	Square Feet

Sheet-Applied Waterproofing: POST-APPLIED

Product	Application Direction	Application Type	Square Feet

DRAINAGE

If the project specification requires drainage/protection, the warranty requires drainage/protection board be installed. If Polyguard brand was not installed, please complete the "OTHER" section below.

POLYFLOW®

Product

Square Feet

TOTALFLOW™

Product

Linear Feet

OTHER

Product Brand Name	Product Name

ACCESSORIES & AMOUNTS USED

PRIMERS, SEALANTS, ADHESIVES, DETAILING

Product	Quantity of Unit(s)

TAPES

Product	Linear Feet

MISCELLANEOUS

Product	Quantity of Unit

SURFACES & SUBSTRATES

Select the surface and substrate that the products were applied to.

Surface/Substrate

If "Other" was selected above, please enter the surface/substrate of the applied product(s)

ADDITIONAL INFORMATION

Please use this area for any information not requested on this form, such as drainage board by others used or specific info to help process the warranty. Any missing information will delay the process.

INSTALLATION COMPLETION DATE

Enter the date that the product installation was completed. This date is REQUIRED.

Date

SUBSTANTIAL COMPLETION DATE

Enter the substantial completion date here ONLY if the specification states such.

Date

PROJECT SPECIFICATION

A copy of the Project Specification is REQUIRED. Please upload your file here in Microsoft PDF or Word format.

PRE-APPROVED WARRANTY REGISTRATION

Material & Labor Warranties must have been pre-approved prior to the project start. Please include a copy of the approved Warranty Pre-Registration that you received from Polyguard showing your Pre-Registration Number. Please upload your file here in Adobe PDF format only.

PRE-REGISTRATION NUMBER

Please enter the Warranty Pre-Registration Number you received from Polyguard.

WARRANTY TERM

Enter the term (# of years) of warranty you are requesting/were pre-approved for. This term MUST match the term specified in the Project Specification.

This application is only valid for a Material & Labor Warranty. Other warranties are available; please refer to our website for additional information.

WARRANTY ISSUANCE

Enter the email address of where you want the approved warranty sent to.

PRODUCT CERTIFICATION

By signing below, I certify that Polyguard's accessories have been used on this project.

Person Completing This Form

Enter the name of the person completing this form.

Email Address

Phone Number

Signature

Signature of person completing/submitting this application.

Date of Signature

Date

Any missing information or incomplete application will delay processing the request. Incomplete applications will be denied and require resubmission. Please allow Polyguard 14 business days to process your completed warranty application.

Be sure to click on the "SUBMIT" button or your application will not be sent to us.

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