Material Partially or Not Installed Claim Form

Claim Form Submission
A copy of this finished form will be sent to the following emails for your records.
Pacmat Rep Email*
Claim Submitter's Email*
RETAILER INFORMATION
Has the Dealer been onsite to view the claim?
- Yes
- No
Dealer Name
Dealer Contact Name
Dealer Phone
Dealer Email
Retailer Address
Street Address Address Line 2 City State ZIP Code
CONSUMER INFORMATION
Consumer Name
Consumer Phone Number
Consumer Email
Consumer address
Street Address Address Line 2 City State ZIP Code
PRODUCT INFORMATION
Product Name
Product SKU
Reference #
Invoice #
CLAIM INFORMATION
Date reported
MM slash DD slash YYYY
Submitted By:
Inspection Requested
- Yes
- No
Does this require an inspection? If yes, please read our Inspection Agreement by clicking here. Should an inspection be required, the dealer will be responsible for the inspection fee in the case there are no manufacturing related issues.
Describe Issue
Please upload photos or a short video (30 seconds or less) of your claim here:
Drop files here or

Max. file size: 50 MB, Max. files: 5.

Claim Form Submission