Dur-A-Glaze MVP Primer
10 Year Limited Warranty Application

To be eligible for the Dur-A-Glaze MVP 10-year Limited Warranty Program,
please complete all fields and submit the application form below:

Application ID:  
FACILITY INFORMATION CONTRACTOR INFORMATION
Contact name: Contact name:
Company name: Company name:
Street address: Street address:
City: City:
State: State:
Zip code: Zip code:
Phone: Phone:
  (ex. 555-555-5555) E-mail:

 

SUBSTRATE INFORMATION
Size of floor: sq.ft. Approx. age of floor: (years)
Slab on grade? Yes No      
Vapor barrier installed? Yes No Unknown If yes, Barrier thickness: Mils
Moisture testing methods:  Relative humidity (ASTM F2170)? Yes No If yes,  Reading:
 Calcium chloride (ASTM F1869)? Yes No If yes, Reading:
Core analysis performed? Yes Declined If yes, Reading:    

 FLOOR SYSTEM  
Estimated installation date: (ex. 00/00/00)
Floor system(s) to be installed:
Additional comments:
Form completed by (name):    
   

INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED
Contact Us: Toll Free: 877-251-5418 • Fax: 860-528-2802