Warranty Request Form

Warranty Request Form

Fill all applicable fields. Confirmation email will be sent upon submittal.
Your Name *
Your Email Address *
Submitter's Phone Number *

Area Code Phone Number
Your CUSTOM Sales Representative Email Address
CUSTOM Architectural Regions - Select your region below: *

GA, NC (Charlotte), SC, TN, AL, MS FL NJ, PA, VA, MD, WV, DE, NC, District of Columbia NY, VT, CT, NH, ME, RI, MA TX, OH, AR IL, WI, MN, ND, SD, IA, MO, OH, MI, IN, KY, NE, KS Southern CA, AZ, NM, ID, WY, MT, CO, UT Northern CA, AK, WA, OR, NV, HI British Columbia, Alberta, Saskatchewan, Manitoba, Yukon, Northwest Territories, Nunavut Quebec Ontario New Brunswick, Newfoundland, Labrador, Nova Scotia, Prince Edward Island
Date - Project Awarded *

Month Day Year
Project confirmed with CUSTOM Products (Can be approximate)
Project Name *
If the project has additional phases and requires more than one warranty, add a description after the name such as Phase 2; exterior facade; pool deck; showers; etc.... in next submission
Project Address, City/State, Zip/Postal Code *
Owner Information - Contact Name, Company Name, Address, City/State, Zip/Postal Code & Phone number
General Contractor Information - Contact Name, Company Name, Address, City/State, Zip/Postal Code & Phone number
Installer/ Sub-Contractor Information - Contact Name, Company Name, Address, City/State, Zip/Postal Code & Phone number
Architectural Firm Information - Contact Name, Company Name, Address, City/State, Zip/Postal Code & Phone number
Project Size (SF / M2) *
Estimated $ Installation Value *
Approximate Date (or time-frame) of Installation *
If international project, provide value in US Dollars
Project Type *

New Construction Renovation Mall Airport Auto Dealership Restaurant Hospital Residential Multi-Residential Industrial Hotel Office Building Sports Facility Dairy / Food Processing School
Application (Check all that apply) *

Interior Floors Interior Showers Interior Walls Exterior Facade Exterior Roof / Deck / Balcony Exterior Vehicular Traffic Kitchen Floors (Epoxy Use) Floor Wear Surface Pool /Water Feature
Finish (Check all that apply) *

Porcelain Tile Gauged Porcelain Tile Panels Resin-backed Gauged Porcelain Tile Panels Glass Tile Stone Tile Terrazzo Tile Resin Agglomerate Tile Resin-backed Tile or Stone Quarry Tile Luxury Vinyl Tile /Luxury Vinyl Plank Sheet Vinyl VCT (Vinyl Composition Tile) Hardwood Engineered Wood Carpet Carpet Tiles Rubber Flooring
Describe Tile Brands/Sizes or Flooring Brands/Sizes and SF if known
NOTE: Certain sized tiles and flooring require specialized mortars/adhesives. Provide specific information of flooring for Warranty Match submittals.
Surface Preparation Products (Check all that apply)

LevelQuik®RS (Rapid Setting) Self-Leveling Underlayment LevelLite® Self-Leveling Underlayment LevelQuik®Advanced Acrylic Primer MBP -Multi-Surface Bonding Primer TechLevel™ 100 Self-Leveling Underlayment TechLevel™ 125 Self-Leveling Underlayment TechLevel™ 150 Self-Leveling Underlayment TechLevel™ XP-1 Self-Leveling Underlayment TechLevel™ WSF Fiber Reinforced Self-Leveling Underlayment TechLevel™ HPT High Performance Topping TechMVC™ MoistureVapor and Alkalinity Barrier TechPrime™ A Acrylic Primer TechPrime™ E 100%-Solids Epoxy Primer Silk™ Patching & Finishing Compound TechPatch™ MP MultipurposeRapid Setting Skim Coat & Floor Patch TechPatch™ RP Ramping Patch TechPatch - TW Tilt Wall FinishingCompound SpeedSlope®- Rapid Setting Sloping Mortar CustomFloat®Bedding Mortar Thick Bed Bedding Mortar Fast Setting Thick Bed Mortar
Membranes (Check all that apply)

RedGard®Crack Prevention and Waterproofing Membrane RedGard®SpeedCoat Waterproofing Membrane RedGard®Uncoupling Mat Custom®9240 Waterproofing and Anti-Fracture Membrane Crack Buster®Pro Crack Prevention Mat Underlayment EasyMat®Tile & Stone Underlayment 5mm EasyMat®Tile & Stone Underlayment 12mm EasyMat®Tile & Stone Underlayment 3mm FractureFree®Crack Prevention Membrane
Tile & Stone Mortars/Adhesives (Check all that apply)

MegaLite®Crack Prevention Mortar MegaLite® Rapid Setting Crack Prevention Mortar ProLite®Tile & Stone Mortar ProLite®Rapid Setting Tile & Stone Mortar VersaBond®LFT Large Format Tile Mortar VersaBond®Fortified ThinSet Mortar VersaBond Flex®Fortified ThinSet Mortar MultiSet - LFT Economical Large Format Tile Mortar MultiSet ModifiedThin-Set Mortar Complete Contact-LFT Rapid Setting Mortar Complete Contact™RS Fortified Mortar Natural Stone & Large Tile Premium LFT Mortar Glass Tile Premium Thin-Set Mortar Porcelain Tile Fortified Thin-Set Mortar PremiumPlus® Standard ThinSet Mortar SpeedSet™ Fortified ThinSet Mortar VersaSet®Fortified ThinSet Mortar SpeedSlope®- Rapid Setting Sloping Mortar EBMLite™ EpoxyBonding Mortar — 100% Solids AcrylPro®Ceramic Tile Adhesive T160™ CeramicTile Adhesive
Grouts / Sealant (Check all that apply)

Prism®Ultimate Performance® Grout Polyblend®Plus Sanded Grout Polyblend®Plus Non-Sanded Grout PolyBlend®Sanded Grout PolyBlend® Non-Sanded Grout Fusion Pro®Single Component Grout™ CEG-Lite™ 100% Solids Commercial Epoxy Grout CEG-IG 100% Solids Industrial Grade Epoxy Grout Commercial 100% Silicone Sealant PolyBlend®Ceramic Tile Caulk StainBlocker for Grout
Tile/Stone & Grout Sealers (Check all that apply)

Aqua Mix®Sealer’s Choice® Gold – Rapid Cure Formula Aqua Mix®Penetrating Sealer Aqua Mix®Enrich ‘N’ Seal™ Aqua Mix®UltraSolv® Aqua Mix®Grout Colorant TileLab®Grout & Tile Sealer TileLab®Stone Sealer & Enhancer
Flooring Adhesives (Check all that apply)

Vinyl™ PSA Vinyl™ VCT Wood™ HP4 Wood™ UR4 Wood™ UR Wood™ ENG
Non-Custom Products in the Assembly
Use Project for Case Study / Marketing?

Yes - Please contact me
Upload project attachments - Pictures, files, specifications, etc... (10 MB limit)

Browse Files

Cancel of
Warranty Term Requested (Years) NOTE: Product selections affect terms

1 5 10 15 25 Lifetime Warranty Match - Adhesives for Floorcovering. Assure exact product names are listed in fields above
Warranty Recipient- Contact Name, Company Name, Address, City/State, Zip/Postal Code & Phone number
Warranty Recipient - Email Address
Provide email address if copy is to be sent directly to reciepient
Copy of Specification Available?

Yes No
Copy of Specification Attached?

Yes No
Pre-Construction Site Inspection Completed?

Yes No To be scheduled
Pre-Construction Site Inspection Date

Month Day Year
Date
Products Specified by Architect/Owner
Project Notes:
Include special circumstances, etc...
Product Use Validation

Warranties require validation that the products selected in this form were used on the project. If this is a request prior to the project's substantial completion, request an additional form below. Sign below if project is completed.
If project is completed, sign below with mouse (or finger on touch screen):

I certify that the above project has reached substantial completion and that the CUSTOM products listed in this document were used in accordance with product Technical Data Sheets. Any substitution of products without notification and approval by Custom may void any warranty. Proof of purchase will be required for warranty claims. Clear
Date of Substantial Completion

Month Day Year
Warranty term begins with above date
Request a Validation Form (Project Not Completed at this Time)

Please send me a form
Internal Use Only

Please do not fill in any fields below
Architectural Approval Date:

Month Day Year
Marketing Approval Date:

Month Day Year
(When necessary)
Technical Services Approval Date:

Month Day Year
Required
Exec Management Approval Date:

Month Day Year
Warranty Issued Date:

Month Day Year
Warranty #:
Should be Empty:

Warranty Request Form

Product Use Validation

Internal Use Only