Leather 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 problem occur?

Please enter date of damage

Description

What is affected? Sectional Sofa Love Seat Chair Ottoman

Please tell us what piece is affected.

What kind of Damage? Rip Tear Burn Cracking/Peeling Stain

Please tell us what kind of Damage Occured.

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 product is the damage?

Please tell us where the damage is

How did the damage happen?

Please give a description on how the damage happened?

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