Polymer Nation - Complaint and Issue Form
Your Information
Your Full Name
Your Phone Number
Your Email
*
Privacy Policy
Distributor Contact
Distributor Name
Who Did You Work With?
Contractor Contact
Name Of Contracting/Install Company
Who Did You Work With?
Their Phone Number or Email
Product and Batch Information
Product Name
Product SKU#
Lot/Batch #A
Lot/Batch #B
Second Product
2nd Product Name
2nd Product SKU#
2nd Product Lot/Batch #A
2nd Product Lot/Batch #B
Add More Products (Optional)
How Many Additional Products Would You Like To Add?
No Additional Products
1
2
3
Name of 3rd Product
SKU of 3rd Product
Lot/Batch #A of Product 3
Lot/Batch #B of Product 3
Name of 4th Product
SKU of 4th Product
Lot/Batch #A of Product 4
Lot/Batch #B of Product 4
Name of 5th Product
SKU # of 5th Product
Lot/Batch #A of Product 5
Lot/Batch #B of Product 5
Site Information & Environmental Conditions (Prior to Application)
Job Address
Room Dimensions and Ceiling Height of Room Being Coated?
Ambient Temp (°F)
RH%
Substrate (Slab) Temp (°F)
Dew Point (°F)
Total Square Footage
Total Square Footage of Project?
Surface Preparation
Method(s) of surface prep (Please explain methods and standards used in detail). What CSP profile was achieved? Are there any contaminants or concerns with the concrete? <ASR, integrity of the concrete, L1 concrete used>
Polymer Nation Products Used
Please explain the system you are installing. (Primer, 1st Coat, 2nd Coat, Topcoat etc.)
Mixing & Application Process
Please explain the surface preparation and cleaning steps you completed.
Mixed in Full Kits?
Yes
No
Any Thinners or solvents used?
Yes
No
Type & size of mixer used?
How Long Was the Product Mixed?
Type of applicator used? (size of notched squeegee and type of roller cover)
Other Details?
Please provide additional details of your application process.
Observation (Complaint or Issue)
Please provide a detailed explanation of the issue or complaint.
Supporting Files/Photos
Actions on site / What is being requested from Polymer Nation?
How Can We Help?