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WARRANTY APPLICATION FORM
D
ISTRIBUTOR
Company Name
*
Applicant Name
*
Email
*
Contact No.
*
PROJECT
Architect Name
*
Contractor Name
*
Sponsor/Owner
*
Project Name
*
Site Address
*
Start Date
*
mm/dd/yyyy
Completion Date
*
mm/dd/yyyy
BQ Qty
*
Actual Qty
*
PRODUCT
Item No.
*
Item Description
*
Application
*
Should you require any assistance, please reach out to: Ms Kishalinee at
kishalinee.ramesh@polyglass.my
or 04-3908460 (ext 129)
*
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