Marquis Industries – Flooring Claim Portal

1

Dealer / Account Information

Marquis Industries Account Name *

Dealer Billing Address *

Dealer Contact Name *

Dealer Contact Phone *

Dealer Email Address * Claim confirmation will be sent here.

Marquis Industries Account Number *

Dealer's Own Claim / Reference # (optional)

2

Invoice & Product Details

Mill Invoice Number *

Invoice Date *

Roll / Pallet Number

Total $ Amount Requested *

Style Name *

Style Number *

Color Name *

Color Number *

3

Affected Quantity

Unit of Measurement *

Amount Purchased * Total SF purchased on invoice

Amount Involved in Claim * SF affected by the defect/issue

4

Installation Status & Dates

Is this product currently being installed right now? *

Yes - Installation is in progress No

Has this product been fully installed? *

Yes No

Installation Details

Installation Date *

Date Issue / Complaint First Noticed *

Date Dealer Inspected

Date Salesman Inspected

End Customer (Your Customer's Information)

Jobsite Contact Name *

Jobsite Contact Phone

Installation Site Address *

Installation Conditions

Type of Installation *

Construction Type

Location of Installation

Subfloor Type *

Moisture Information

Moisture Reading Taken of Sub-Floor?

Yes No

Moisture Reading %

Moisture Barrier Used?

Yes No

Relative Humidity (RH%) in Installation Area

5

Reason for Complaint

Complaint Category *

Description of Defect / Important Information *

6

Samples & Photos

Samples Available for Testing? *

Yes - I can provide samples No

A minimum of 12"×1' of vinyl/carpet or 3 full-length boards of LVP are required for lab testing.

Upload Photos of the Affected Area(s)

📷

Click to upload or drag & drop photos here

JPG, PNG, HEIC accepted. Please submit photos of all areas of concern.

Photos greatly assist the claims team in their evaluation. Multiple photos recommended.

7

Certification & Acknowledgment

⚠️ IMPORTANT — Please Read Before Signing:

DO NOT INSTALL VISIBLY DEFECTIVE PRODUCTS. Material and labor will not be considered on any product installed with visible defects. Marquis Industries reserves the right to make repairs on ALL repairable defects. Replacement is an option for non-repairable defects only. Allowance consideration is determined by the degree of defect.

Print Name *

Date *

I certify that the information provided in this claim is accurate and complete to the best of my knowledge, and I have read and understand the terms above.

Submit a Flooring Claim

Dealer / Account Information

Invoice & Product Details

Affected Quantity

Installation Status & Dates

Reason for Complaint

Samples & Photos

Certification & Acknowledgment