HBW_305_061713
NOTICE OF COMPLAINT FORM
FOR WORKMANSHIP & SYSTEMS COVERAGE
mail TO:
2-10 Home Buyers Warranty
10375 East Harvard Ave., Suite 100 | Denver, CO 80231 | 855.429.2109
| FAX: 303.306.2239
Homeowner Signature:
Homeowner Signature:
Date:
CHECK ONE
(IF APPLICABLE)
: 1)
FHA 2)
VA 3)
RHS
CASE #:
Attach any copies of relevant correspondence between you
and your Builder/Seller involving this matter. Please provide
any correspondence that indicates that your Builder/Seller has
failed to perform his/her warranty obligations, and a copy of
the Certificate of Warranty Coverage.
Please read the 2-10 Home Buyers Warranty® Booklet, section IV, page 5, for filing instructions and pertinent information. If your previous
written attempts to resolve your problems with the Builder/Seller have failed, then this form is to be sent to your Builder/Seller, with a copy
to the HBW Warranty Administration Office. This form must be received by your Builder/Seller and HBW no later than fifteen (15) days after
the expiration of the applicable warranty term. We recommend certified mail, return receipt.
Name:
Address of Complaint:
Home Phone:
Business Phone:
Email Address:
Effective Date of Warranty:
Certificate of Warranty Coverage #:
Nature of Defect
(Be Specific):
Date Defect First Observed:
Date First Reported to Builder/Seller:
Attach any copies of relevant correspondence between you and your Builder/Seller involving this matter. Please provide any correspondence
that indicates that your Builder/Seller has failed to perform his/her warranty obligations, and a copy of the Certificate of Warranty Coverage.
By filing this Notice of Complaint you agree to resolve any disputes using arbitration as described on pages 6 and 7 of the Booklet.
