Warranty

Tell us about the claim

Homeowner Name

First

Last

Homeowner Phone

Homeowner Email

Why I'm filling out this form

I was asked by the homeowner to start the claim
I was asked by the product point-of-sale to start the claim
I was not asked by anyone else to start this claim, but am proactively starting it on my own

Installation/Claim Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Briefly describe the problem

Common installation locations

Use the diagram above as a reference and let us know where MiraTEC/Extira are installed on the home.

Installation Locations

Photos of installed product

Click or drag files to this area to upload. You can upload up to 20 files.

Upload photos of the problem areas – both full views and up close detail images – to help expedite the claim review process in .png, .jpg, .gif, .doc, .pdf, .xls, .ppt, .mpg, .mov, or .wmv file formats

Installation and Purchase History

When was the product installed? (approximately, if exact date isn't known)

How much product is stored on the site? (Approximate pieces)

How much product is part of this claim? (Approximate pieces)

Detail of material in claim - list all materials and sizes known

Upload Product Documentation

Click or drag a file to this area to upload.

Upload images of your unit tags or other order/purchase paper work to help expedite the claim review process in .png, .jpg, .gif, .doc, .pdf, .xls, .ppt, .mpg, .mov, or .wmv file formats

Where was the product purchased (distributor or dealer store name)?

Purchase Location Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Purchase Location Phone

When was the material delivered to the job site? (Approximate)

Is the home/project currently under construction, or newly finished (and still builder owned)?

Yes
No

Builder/Contractor for the Project

Builder/Contractor Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Site Photos

Click or drag a file to this area to upload.

Upload jobsite photos, preferably including images showing on-site material storage if available, to help expedite the claim review process in .png, .jpg, .gif, .doc, .pdf, .xls, .ppt, .mpg, .mov, or .wmv file formats

Original Purchase Documentation

Click or drag files to this area to upload. You can upload up to 5 files.

Upload original purchase documentation to help expedite the claim review process in .png, .jpg, .gif, .doc, .pdf, .xls, .ppt, .mpg, .mov, or .wmv file formats

Review and Submit

Consent to contact

I agree

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product Site describe

Start Your Warranty Claim

Tell us about the claim

Common installation locations

Installation and Purchase History

Review and Submit