ESR Chairmats / Chair Mat Warranty Form

ES Robbins: Innovative Floor and Desk Protection Solutions

Warranty Claim Form

Please complete the warranty claim form. You will need to supply us with an approximate date of purchase, the UPC code from your product label and the location you purchased the product from.

Name:
Company:
Address:
City:
State:
Zip:	(ZIP Code)
Daytime Phone:	(Phone Number)
Fax:
Email:	(E-mail)

Date of Purchase:
UPC Code:
Place of Purchase:

Size of Chairmat
36" x 48"
45" x 53"
46" x 60"
48"
60"
Other (Specify):

Shape of Chairmat
Lipped:
Rectangular:
Round:
Oval:
Square:
Other (Specify):

Edge of Chairmat
Straight:		Bevel:

Reason for Replacement (Please check all that apply)		Comments:
Damaged:
Cracked:
Chipped:
Broken:
Shattered:
Other (Specify):
Shipping charges will apply to most warranty replacements. Upon approval of your claim, a customer service representative will contact you to arrange payment of shipping charges.

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