Palmex PALMITA registration form

1General client information

2Installer information

3Distributor information

4Project information

General client information
Full legal name (company, hotel, individual…)*
Contact person's full name*
Title
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Installed to an other address
- Installed to an other address
Address of location where the Palmex™ products are installed
Street Address City State / Province / Region ZIP / Postal Code Country

Installer information

This page is optional, you can skip it if you have no Installer information
Company legal name
Contact person's full name
Title
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone
Email

Distributor information

This page is optional, you can skip it if you have no distributor information
Company legal name
Contact person's full name
Title
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone
Email

Project information
Job type*
- New installation
- Re-Roofing
Project description (Gazebo, Restaurant, Pool house etc…)
Product*
Model*
Color*
Roof surface (sqm/sqft)*
Unit
Invoice # / Order #*
Installation date*
YYYY slash MM slash DD
Where did you learn about Palmex*
File*
Drop files here or

Max. file size: 1 MB.
In order to activate your warranty, Palmex requires a minimum of 3 photos of your installation taken at different angles and a copy of your invoice. (The pictures must be JPG files and 3 Mo maximum.)

The pictures and the invoice must be submitted to Palmex with this form to activate the applicable warranty within thirty (30) days of installation of the product, as per the terms and conditions of the Palmex Limited Product Warranty.
- I authorize Palmex to use my photos
Signature*
Date (yy/mm/dd)*
YYYY slash MM slash DD
Phone
This field is for validation purposes and should be left unchanged.