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Roof Coatings | Claims Form
Customer Information
Purchase Information
Date of Purchase
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Products Purchased (select one or more)
AS210, ACRYLIC PRIMER SEALER
CC765, SILICONIZER CRACK FILLER CAULK
RC230, SILICONZER CRACK FILLER
RC300, LANCO SEAL ROOF COATING
RC3700, COOLGUARD ROOOF COATING
RC3757, PRO RC ROOF COATING
RC994, URETHANIZER ROOF COATING
UL221, ULTRA LEVEL
WL2823, DURA-LIFE CLEAR SEALER
RC200, SILICONZER
RC865, WHITE SEAL
RC886, WHITE SEAL PLUS
RC905, ULTRA SILICONIZER
MD859, AQUA-PROOF PREP
MD856, AQUA-PROOF PRIMER
DL3758, DURA-LIFE COLOR COAT
Job Information
Date of Application
Estimated Square Footage of Roof
Type of Roof
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Asphalt - SBS (Styrene-butadiene-styrene)
Asphalt - APP (Atactic polypropylene)
Asphalt Shingles
Built Up Roofing
Concrete
Concrete/Clay Barrel Tile
Concrete/Clay Flat Tile
EPDM Rubber
Metal - Exposed Fastener
Metal - Factory Finish Coating
Metal - Galvanized
Metal - Standing Seam
Previously Coated - Acrylic
Previously Coated - Asphalt
Previously Coated - Silicone
PVC
Spray Polyurethane Foam
TPO
Wood
Unknown
Other (Please Specify)
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Was the roof previously coated?
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Yes
No
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Is the water ponding?
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Yes
No
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