Reset Form
Erickson's Flooring & Supply Co.
Claim in Process Form
Fax to: 888.543.9663 Attn: Claims Dept.
Mail to: 1013 Orchard St. * Ferndale, MI * 48220
For assistance processing this form, please call 800.225.9663, ext. 1128, or 248.246.5013 direct.
PRODUCT:
CITY:
NAME OF PERSON SUBMITTING:
DATE :
NAME OF COMPANY:
PHONE:
Before delivering paperwork to the claims dept, all of the following must be completed and attached .
Claim Type (circle one)
Moisture
Milling
Grading
Finish
Color
Delamination
Samples or photographs to be sent to the vendor :
Maint
Installation
Other
YES
NO
YES
NO
**Do not send samples directly to the vendor. Please forward all samples to EFS claims department.
Erickson's Invoice number(s) :
Consumer Name:
Material run date (if applicable) :
Copies of all other bills that need reimbursement :
Requested amount(s) for claim resolution:
Credit
$
for
square feet of
Credit
$
for
Delivery Charge
Credit
$
for
Restock Charge
Credit
$
for
(Item number)
(Please explain)
Total credit expected:
$
Erickson's Flooring & Supply Co.
Inspection Analysis Report
Date :
Information
Dates:
Delivered
Purchased
Installed
Order/Invoice number
Seller:
Company Name
Address
City
State
Zip
Phone Number
Installer:
Company Name
Address
State
City
Zip
Phone Number
Consumer:
Name
Address
City
State
Zip
Phone Number
Product
Product/Item:
Run date:
Mfgr. markings:
Application
Residential
Light commercial
Heavy commercial
Quantity purchased/used:
YES
YES
YES
NO
NO
NO
New construction
Remodel
Room/Job size:
Nail / Staple Down
Type of fastener :
Size of fastener :
Machine used :
Spacing :
How spacing was checked:
Expansion space :
Where is expansion:
How expansion checked:
Glue used:
How glue was checked:
Glue Down
Type of adhesive:
Amount used:
Notch type/size/spacing:
Open time:
Was floor rolled:
Roller weight:
YES
YES
NO
NO
YES
NO
Subfloor
Thickness:
Total subfloor configuration:
Filler/Topping used:
Plywood
Grade:
OSB
Particle Board
Above On Below
Concrete
Explain:
Construction
Crawl Space:
Vented:
Joist spacing:
Basement:
Heated:
YES
YES
NO
NO
YES
YES
NO
NO
Vapor barrier used:
What kind:
How used/Applied:
Heating:
What type:
YES
NO
Additional Info
Moisture content in finished floor:
Moisture content in subfloor:
Anything noted before install:
Anything noted after install:
Job Conditions
Dog/Cat
Direct sunlight:
Heavy furniture:
Humidity:
Weather:
YES
YES
YES
High
Hot
Dry
Outside temperature:
Inside temperature:
NO
NO
NO
Average
Warm
Damp
Moisture content in left over floor:
Maintenance products:
Other:
Relative humidity:
Air circulation:
Good
Humidifier:
YES
Working:
YES
Date last checked:
Low
Cold
Wet
Fair
Poor
NO
NO
____/____/____
Sanding Procedure
Papers used:
Screens used:
Machine(s) used:
Finishing Procedure
Bleach:
Stain:
YES
NO
Brand:
Dry time:
YES
NO
Brand:
Coats Applied: 1 2
Application method:
Times bleached: 1
____
Brush
Color:
Dry time:
Rag
2
3 ___
Other:
Sealer:
YES
NO
Brand:
Coverage:
Dry time:
Coats Applied: 1 2 ____
Application method: __________ Times catalyzed:
Top Coats:
YES
NO
Brand:
Coverage:
sq ft/gal
Gloss
Semi
Satin
Coats Applied: 1 2 ____
Application method: ______________________________________
Dry time:
Times catalyzed:
Moisture Meter: Used before coats
Moisture % before:
YES
NO
Used between coats:
Moisture % between:
YES
sq ft/gal
NO
Seller Comments/Recommendations
Before:
After:
Name (print):
Date: ____/____/____
Installer Comments/Recommendations
Before:
After:
Name (print):
Date: ____/____/____