Product Warranty Request Form

(For reference "the process of using the Products listed in point 3 for the purposes set out in point 4, applied in the manner described in point 5 for the area described in point 6 in the location set out in point 7 and 8 will be referred to as 'Durotech Product Application')

I confirm that I am the Contractor in charge of the building/development/construction of the location stated at point 7 and 8 and I am properly authorised and in a fully informed position to make these statements.

I certify, that the 'Durotech Product Application was implemented and I confirm that no Durotech representative or employee were present prior or during the Durotech Product Application process or involved in any aspect of Application noted in point 5.

I understand that Durotech will rely on this certificate in order to issue a report approving the use of Durotech’s Products and that the information on this certificate may be required and relied upon for warranty purposes at a later date. I understand that improper use or application of Durotech Products may result in their failure which may result in legal action or an award of damages against Durotech. As such, I further certify and declare that the facts, details and information herein are correct and that the Durotech Product Application has been conducted in strict accordance with Durotech’s specifications and manuals as at the date of purchase of the Product (see point 2).

I understand that Durotech will rely on this certificate in order to issue a report approving the use of Durotech's Products and that the information on this certificate may be required and relied upon for warranty purposes at a later date. I understand that improper use or application of Durotech Products may result in their failure which may result in legal action or an award of damages against Durotech. As such, I further certify and declare that the facts, details and information herein are correct and that the Durotech Product Application has been conducted in strict accordance with Durotech's specifications and manuals as at the date of purchase of the Product(see point 2).

By signing below I acknowledge and confirm that I have read, understood and agreed to what has been stated above and will incur any liability/tort and indemnify Durotech against any claim, expense or order for costs arising from any errors in the aforementioned material.