Fabric Protection Claim

Customer Name and Phone Number

Customers Name

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Customer Home Phone

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Customer Alt Phone

Email Address

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Customer's Address

Customer Address

Customer Address 2

City

State

Zip Code

Claim Information

Account Number (if available)

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Invoice Number (if available)

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When did the Stain Happen?

Please enter date of Stain

Description

What is affected? Sectional Sofa Love Seat Chair Mattress Dining Room Chair Rug

Please tell us what piece is affected.

What kind of Stain? Bodily Fluid Beverage Food Other

Please tell us what kind of Stain.

Specifically, what caused the stain? ie. Coke, Oil, Bloodie. Coke, Oil, Blood

Please be specific about the substance that caused the stain.

Where on the piece is the stain?

Please tell us where the stain is?

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