HEXIS Americas

Product Claim Form

This form is for authorized HEXIS Americas distributors to file a product claim on behalf of a customer. Please have your claim details, purchase dates, and any supporting photos or video ready before you begin.

Note: HEXIS Americas sells through distribution only — this form should be completed by the distributor, not submitted directly by an end customer.

Submit a Claim

All fields revealed below are required unless marked optional.

1 Distributor Information

Distributor Company Name*

Please enter the distributor company name.

Distributor Email*

Please enter a valid email address.

Distributor Internal Claim ID #*

Please enter your internal claim ID.

2 Customer Information

Customer Name*

Please enter the customer's name.

Customer Business Name*

Please enter the customer's business name.

Customer Business Address*

Please enter the customer's business address.

Customer Phone*

Please enter a phone number.

Customer Email*

Please enter a valid email address.

3 Claimed Product

Product Series*

Please select a product series.

Product Code / SKU*

Please enter the product code or SKU.

Batch / Lot Number*

Please enter the batch or lot number.

Size*

Please enter the size.

Amount Claimed*

Please enter the amount claimed.

Description of the Claim*

Please describe the claim.

Date of Purchase*

Please enter the purchase date.

Date of Product Use*

Please enter the date of product use.

Date Issue Was First Noticed*

Please enter the date the issue was first noticed.

How was the install surface prepared?*

This field is required.

What installation techniques were used?*

This field is required.

What was the post-heat temperature used?*

This field is required.

Where is the product primarily located?*

This field is required.

How was the film cared for after install?*

This field is required.

What cleaning products and techniques were used?*

This field is required.

How was the install surface prepared?*

This field is required.

What installation techniques were used?*

This field is required.

Where is the product primarily located?*

This field is required.

How was the film cared for after install?*

This field is required.

What cleaning products and techniques were used?*

This field is required.

Printer Manufacturer*

This field is required.

Printer Model*

This field is required.

Ink Type*

Please select an ink type.

Ink Brand*

This field is required.

Ink Product Code*

This field is required.

Printer Color Set*

This field is required.

ICC Profile*

This field is required.

RIP Software*

This field is required.

How long after printing was the film laminated?*

This field is required.

How long after printing was the film cut or plotted?*

This field is required.

Additional Details*

This field is required.

4 Sample Availability

12" x 12" Sample(s) Will Be Required To Fully Investigate Any Claim. Are You Able To Provide Samples of The Claimed Material?*

Yes No

Please let us know whether a sample can be provided.

*Samples must contain or otherwise be representative of the claim issue. A new, “unused” sample is required to process all claims. If a used sample is being provided, it must be placed on spare liner prior to shipping. All samples should be labeled on the liner with their respective batch number.

5 Supporting Files

Upload Photos or Video To Illustrate The Claim Issue.

Click to upload, or drag and drop files here

Photos, video, and documents accepted (JPG, PNG, HEIC, WEBP, GIF, MP4, MOV, AVI, WEBM, PDF, DOC/DOCX). You can select multiple files.

6 Acknowledgements

I Acknowledge that Proof of Destruction of the claimed material is required to be provided should the claimed material be deemed non-compliant. Proof of destruction will include photos and/or video of all of the claimed material being removed from installed surfaces and/or any unused material being destroyed so that it is fully unusable and disposed of in a waste container.

Please acknowledge this statement to continue.

By submitting this form, I certify that all information provided herein is accurate, complete, and truthful to the best of my knowledge. I understand that submitting false, misleading, or incomplete information may result in the denial of this claim. Furthermore, I acknowledge and agree that no credit, refund, or replacement will be issued unless verifiable proof of destruction of the claimed product is provided. Acceptable forms of proof of destruction include photo or video documentation clearly showing the destruction of the product, or physical return of the damaged item if requested. I understand that failure to provide proof of destruction may result in this claim being denied in full.

Please acknowledge this statement to continue.