Service Claim Form

*Please fill out for all remakes, repairs, and or service claims. We will need this to open your file. (Please note that we only service products that were bought from A Modern Window)

First Name *

Last Name *

Phone *

Address *

Province *

City *

General Purchase Date *

Postal code *

Location of the Blind or Shade

Type of Blind or Shade

Please select the reason for remake that best describes the defect

Fabric or Slat Defect

Size is Incorrect

Wrong Color

Headrail or Bottom Rail is Defective

Parts/ Components are Missing or Broken

Does Not Raise or Lower

Ordered Features are Missing

Dealer | Customer Error

Damage in Shipping

Did not receive Complete Order

Other

Type of Service | Warranty Work

Limited Life Time Warranty (To be Approved by Manufacturer

Damaged from Manufacturer

Other

Additional Information

Upload Pictures or Video

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Signature

Clear

Request Date

Customer Consent

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