Claims Form - Del Conca Porcelain Tiles

Claims Form

Date *

Business Name *

Area Rep Name *

Address *

USA
Canada

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Canada Address *

Phone *

Email *

Order # *

Original PO #

End User

Material Code *

Description / Color *

Size *

Shade *

Gage / Caliber *

Disputed Quantity

# of Pallets / # of Parcels *

SF *

Feet Linear *

# of Items *

Specific Complaint

Multiple Choice *

Quality Complaint
Shipping Complaint

Quality Complaint *

Grade Defects
Cleanability
Shade
Squareness
Planarity
Packaging
Gauge / Caliber
Other

Description *

Shipping Complaint *

Truck did not show up
Inventory Shortage
Overage qty Shipped
Incorrect Item
Incorrect Caliber
Incorrect Shade
Damaged Product
C.S. Error
Other

Description *

Complaint Amount

Order Total Amount *

Claim Amount *

Explain

Customer Resolution

Request *

Damage Compensation
Tot. Discount on Invoice
Part. Discount on Invoice
Solution to Problem
Tot Replacement of Material
Partial Replacement

Other Notes

Form Completed By: *

First

Last