Application for MATERIAL Warranty - Up To 5…

Page 1

All fields with a red asterisk are required.

CONTACT INFORMATION

Enter name of project

PROJECT

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

All fields must be completed.

Address 1

City

ZIP / Postal Code

State / Province

Project Address

Enter Owner Name

OWNER

All fields must be completed.

Address 1

City

ZIP / Postal Code

State / Province

Owner Address

Owner Contact Name

Owner Contact Phone Number

Enter Firm Name

INSTALLER

All fields must be completed.

Address 1

City

ZIP / Postal Code

State / Province

Installer Address

Installer Contact Name

Installer Contact Phone Number

Enter Firm Name

ARCHITECT / ENGINEER

All fields must be completed.

Address 1

City

ZIP / Postal Code

State / Province

Architect / Engineer Address

Architect / Engineer Contact Name

Architect / Engineer Contact Phone Number

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

CONSULTANT

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

Address 1

City

ZIP / Postal Code

State / Province

Consultant Address

Consultant Contact Name

Consultant Contact Phone Number

Enter Firm Name

GENERAL CONTRACTOR

Address 1

City

ZIP / Postal Code

State / Province

General Contractor Address

General Contractor Contact Name

General Contractor Contact Phone Number

Enter Firm Name

DISTRIBUTOR

Address 1

City

ZIP / Postal Code

State / Province

Distributor Address

Distributor Contact Name

Distributor Contact Email

Distributor Contact Phone Number

Page 2

MEMBRANES & AMOUNTS OF MATERIALS USED

Please complete a row for each product applied. Batch Number(s) are required for all fluid-applied products.

Product	Application Type	Batch Number(s)	Square Feet

Fluid-Applied Air Barriers

Complete this section for ONLY 36" membranes

Product	Application Type	Size	Square Feet

Sheet-Applied Air Barriers

Complete this section for any/all cut sizes 6"to 24". Only the UV named products are approved for Roofing Underlayment & Planter/Roof Garden applications.

Product	Application Type	Size	Square Feet

Sheet-Applied Flashings

AIR BARRIERS & FLASHINGS

Please complete a row for each product applied. Batch Number(s) are required for all fluid-applied products.

Product	Application Type	Batch Number(s)	Square Feet

Fluid-Applied Waterproofing

Product	Application Direction	Application Type	Square Feet

Sheet-Applied Waterproofing: PRE-APPLIED

Product	Application Direction	Application Type	Square Feet

Sheet-Applied Waterproofing: POST-APPLIED

Product	Application Type	Square Feet

Sheet-Applied Waterproofing: BALCONY

Product	Application Type	Square Feet

Specialty Sheet Membranes

WATERPROOFING

Page 3

DRAINAGE

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

Product

POLYFLOW®

Square Feet

Product

TOTALFLOW™

Linear Feet

Please complete this section if drainage/protection board installed was not Polyguard brand.

Product Brand Name	Product Name

OTHER

ACCESSORIES & AMOUNTS USED

Product	Quantity of Unit(s)

PRIMERS, SEALANTS, ADHESIVES, DETAILING

Product	Linear Feet

TAPES

Product	Quantity of Unit

MISCELLANEOUS

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

Surface/Substrate

SURFACES & SUBSTRATES

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

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.

ADDITIONAL INFORMATION

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

INSTALLATION COMPLETION DATE

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

SUBSTANTIAL COMPLETION DATE

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

PROJECT SPECIFICATION

This application is only valid for a Material Only of 1 to 5 years. Other warranties are available; please refer to our website for additional information.

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

WARRANTY ISSUANCE

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

PRODUCT CERTIFICATION

Enter the name of the person completing this form.

Person Completing This Form

Email Address

Phone Number

Signature of person completing/submitting this application.

Signature

Date of Signature

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.

Application for MATERIAL ONLY Warranty (Up to 5 Years)

All fields with a red asterisk are required.

CONTACT INFORMATION

MEMBRANES & AMOUNTS OF MATERIALS USED

DRAINAGE

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

ACCESSORIES & AMOUNTS USED

This application is only valid for a Material Only of 1 to 5 years. Other warranties are available; please refer to our website for additional information.

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.