Date (Received By ACP)
 
CLAIM FORM
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Claim Number(Supplied By ACP): Claim Date:  2/4/2012 Status: New
*Company: 
*Contact:
*Address: 
*City: 
*State: 
*Zip:
*Phone:
*Fax:
*Email:
* Amerimax Coated Products, Inc.

 215 Phillips 324 Rd
Helena, AR 72342
1411 North Daly St.
Anaheim, CA 92806
*ACP Coil Tag # *ACP Part Number *Claim Weight *ACP SO # *Claim Description *Date Received

CLAIM INFORMATION

*Complaint Description:  (Describe specifically what and where the defect is in the material, and if the material is in coil or flatsheet form.)
Samples Sent:   Pictures Sent:  
When were samples or pictures sent?