Customer Service Request Form printable pdf download

CUSTOMER SERVICE REQUEST FORM

(Please print the following information)

Name_____________________________________________________________________________________________

Street________________________________________City_____________________State_________Zip____________

Daytime Phone ( ) __________________________Evening Phone ( ) _____________________________________

………………………………………………………………………………………………………………………………..

(Please tell us which product(s) you are having a problem with:

Mattress ( )

Box Spring ( )

Both ( )

…………………………………………………………………………………………………………………………………

In order to accurately and quickly process your request, we will need you to fill in the following information from

the law tags of both your mattress and the box spring, even if you are claiming service on only one. Please locate

the law tags of both your mattress and box spring. (Law tags can be found attached to the foot of the piece).

If your law tag is missing, the manufactures warranty is voided.

If you do not use a box spring then please write in “None used”.

For Mattress

For Box Spring

Model Name

___________________________

Size

___________________________

Warranty

___________________________

Date Made

___________________________

…………………………………………………………………………………………………………………………………

Please indicate the date and the location of purchase.

For Mattress

For Box Spring

Date of Purchase

___________________________

Dealer & Location

___________________________

…………………………………………………………………………………………………………………………………

As clearly and specifically as possible, tell us about your complaint. Include pictures of problems that are visible.

(If you are having problems with both the mattress and the box spring, describe both sets of problems and indicate

which pertain to the box spring and which to the mattress.)

Customer Service Request Form