Company Name(Required)

Company Address(Required)

Street Address Address Line 2 City State ZIP Code

Customer Contact Person: Name(Required)

Phone Number(Required)

Email Address(Required)

Customer Order Number (If Known)

Shipping Address, or Warehouse Location (Boise, Spokane, or Tri-Cities) if Freeform will Perform Install(Required)

Street Address Address Line 2 City State ZIP Code

Receiving Contact Person Name (if applicable)

Receiving Contact Person Phone (if applicable)

Detailed Description of Issue (including how issue happened, if applicable)(Required)

Pictures of Issue (Overall picture of furniture, close-up of damage or issue, product sticker/label).(Required)

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Pictures of Issue (Overall picture of furniture, close-up of damage or issue, product sticker/label).(Required)

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Warranty Service Request