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WARRANTY FORM INFO

The Premium Solid Source, L.L.C.
8009 W. Olive, Peoria, AZ 85345
Phone: (877) 853-1805 Toll-Free or
Phone: (623) 776-7373
e-mail: LG HI-MACS

(* = required)


*First Name

*Last Name

*Your e-mail

*Street Address

Suite or PO BOX

*City

*State		Zip Code

Phone

Date of Purchase

HI-MACS used for (check all that apply):
		Kitchen Countertop
		Bath Tub Surround/Deck
		Shower Wall
		Wall Cladding
		Serving Counters
		Vanity Top
		Wet Bar
		Lab Counters
		Other

Was HI-MACS purchased for remodeling?
	Yes	No

HI-MACS Dealer/Builder
*Fabricator/Installer Full Name
Address
City
*State
Zip
Phone
*Date of Installation		(xx.xx.xxxx)

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