Palmex PALMITA registration form

1 General client information

2 Installer information

3 Distributor information

4 Project 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*
Serial # (on the bundle)
Model*
Color*
Type*
- Regular
Roof surface (sqm/sqft)*
Unit
Invoice #*
Installation date*
Date Format: YYYY slash MM slash DD
Where did you learn about Palmex*
File*
Drop files here or
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.
Signature*
Date (yy/mm/dd)*
Date Format: YYYY slash MM slash DD