APPLICATION FOR 5 YEAR MATERIAL PRODUCT WARRANTY FORM
Warranty issue date will be based upon completed application of these products.
Project Type (check one)1 Mass Transit / 11 Military facilities
1. Project: / 2 Parking garages / 12 Churches
Building: / 3 Office bldgs/hdqtrs / 13 Retail
Street Address: / 4 Stadiums / Arenas / 14 Residential–single*
City, State and Zip: / 5 Entertainment Complex / 15 Residential–multi *
2. Owner: / 6 Medical / 16 Industrial
Owner: / 7 Schools/Universities / 17 Hotels / Motels
Street Address: / 8 Convention Centers / 18 Utilities
City, State and Zip: / 9 Government Facilities / 19 Other – not listed
Attention: / 10 Airports
*No warranties are issued for Underseal TM on residential projects
3. Installer:
Firm:
Street Address:
City, State and Zip:
Attention: / Phone: / (()- ext:
4. Architect / Engineer:
Firm:
Street Address:
City, State and Zip:
Attention: / Phone: / (()- ext:
5. General Contractor:
Firm:
Street Address:
City, State and Zip:
Attention: / Phone: / ()- ext:
Job Site Contact and Phone Number: / ()- ext:
6. Distributor:
Firm:
Street Address:
City, State and Zip:
Attention: / Phone: / (()- ext:
7. Type and Amount of Material Used:
Product Used / ApplicationType (please specify by type listed below) / U / M / Quantity
Elevator, Foundation, Mechanical Interior, Plaza/Deck, Tunnel, Other (describe)
Fluid-Applied Air Barrier: / Application Type
AirLok Flex (525 VOC): / with ProBan / Batch # / Sq. Ft.
AirLok Flex (400 VOC): / with ProBan / Batch # / Sq. Ft.
AirLok Flex (200 VOC): / with ProBan / Batch # / Sq. Ft.
AirLok Flex (100 VOC): / with ProBan / Batch # / Sq. Ft.
AirLok Flex VP: / with ProBan / Batch # / Sq. Ft.
AirLok Flex WG: / with ProBan / Batch # / Sq. Ft.
Fluid-Applied Dampproofing: / Application Type
Pro 1000: / with ProBan / Batch # / Sq. Ft.
Fluid-Applied Waterproofing: / Application Type
Stretch (525 VOC): / with ProBan / Batch # / Sq. Ft.
Stretch (400 VOC): / with ProBan / Batch # / Sq. Ft.
Stretch (200 VOC): / with ProBan / Batch # / Sq. Ft.
Stretch (100 VOC): / with ProBan / Batch # / Sq. Ft.
Sheet-Applied Waterproofing: / Application Type
Underseal Underslab: / Sq. Ft.
Underseal Blindside: / Sq. Ft.
PRM/Splitslab: / Sq. Ft.
650 Membrane: / Sq. Ft.
Other: / Application Type
Other (Explain): / Brand / Sq. Ft.
Other (Explain): / Brand / Sq. Ft.
Additional Information:
8. Polyguard Products Accessories Purchased For This Project:
Type of Accessory / Product Used / U / M / Quantity
Adhesives & Mastics:
650 Mastic(check one) / 30 oz. tube / or 5 gal. pail / (check size)
Detail Sealant PW(check one) / 20 oz. sausage / or 3 gal. pail / (check size)
650LT Adhesive or California Sealant / 1 gal. can / or 5 gal. pail / (check size)
LM85 Self-Leveling 2-part liquid membrane / 5 gal. pail
LM95 2-part fast-cure liquid membrane / 2 gal. pail
Shur-Tac Water Based Adhesive / 5 gal. pail
STA-PUT Quick Grip Spray Adhesive / Canister
Drainage:
LowFlow / Sq. Ft.
PolyFlow 10(check one) / 10 or / 10-P / Sq. Ft.
PolyFlow 15(check one) / 15 or / 15-P / Sq. Ft.
PolyFlow 18H / Sq. Ft.
Total-Flow / Sq. Ft.
Sheet Membranes:
300 Membrane 30 mil flashing / Sq. Ft.
400 Membrane 40 mil flashing / Sq. Ft.
UV 365 Membrane 30 mil flashing / Sq. Ft.
300 or 400 Membrane / Sq. Ft.
Deck Guard HT / Sq. Ft.
NW-75 Membrane / Sq. Ft.
Tileguard / Sq. Ft.
Tapes:
606 Tape / Sq. Ft.
650 Detail Tape / Sq. Ft.
Underseal Fabric Seam Tape / Sq. Ft.
Misc:
6” Poly Covers / Each
Underseal Preformed Column Corner / Each
Underseal Preformed Inside Corner Boot / size: 12” / 18” / 24” / Each
Universal Outlet / Each
Universal T / Each
9. Surfaces / Substrates that Products were applied to:
Concrete / CMU Block / Gypsum Sheathing / Other
ICF / OSB / Plywood Sheathing / Other
10. Installation Completion Date: / * / Substantial Completion Date: / *
*RE: Substantial Completion: Proof of requirement must be issued upon warranty request by substantial completion date.
*Both Installation & Substantial completion dates must be entered above upon warranty request by substantial completion date.
11. Warranty Requested: / 5 year Material Warranty
All warranties must be pre-approved. All warranties require that drainage board (if used) MUST be Polyguard brand.
Please contact your Polyguard Products Regional Manager when a special term warranty may be needed.
No special term application or warranty will be issued without prior approval by Architectural Division Management.
Please check below of preference to receive your warranty:
Mail warranty to: / Company Name:
Street/P.O. Box:
City, State, Zip: ,
E-mail warranty to:
By signing below, I certify that only Polyguard Products accessories & drainage board have been used on this project.
I understand that typing my name below serves as an electronic signature for purposes of this form.
Completed by:
Signature Print Name Date
Mailing: ENNIS, TEXAS 75120-0755
Shipping: 3801 S. HWY. 45 ENNIS, TEXAS 75119
PH: 214-515-5000 FAX: 972-875-9425
E-Mail:
Web Site: WARRANTY APPLICATION 5 Year Material R05.02.13.doc
Page 1 of 3