"Customer Service Request Form - Mattress City"

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CUSTOMER SERVICE REQUEST FORM
(Please print the following information)
Name_____________________________________________________________________________________________
Street________________________________________City_____________________State_________Zip____________
Daytime Phone ( ) __________________________Evening Phone ( ) _____________________________________
………………………………………………………………………………………………………………………………..
(Please tell us which product(s) you are having a problem with:
Mattress ( )
Box Spring ( )
Both ( )
…………………………………………………………………………………………………………………………………
In order to accurately and quickly process your request, we will need you to fill in the following information from
the law tags of both your mattress and the box spring, even if you are claiming service on only one. Please locate
the law tags of both your mattress and box spring. (Law tags can be found attached to the foot of the piece).
If your law tag is missing, the manufactures warranty is voided.
If you do not use a box spring then please write in “None used”.
For Mattress
For Box Spring
Model Name
___________________________
___________________________
Size
___________________________
___________________________
Warranty
___________________________
___________________________
Date Made
___________________________
___________________________
…………………………………………………………………………………………………………………………………
Please indicate the date and the location of purchase.
For Mattress
For Box Spring
Date of Purchase
___________________________
___________________________
Dealer & Location
___________________________
___________________________
…………………………………………………………………………………………………………………………………
As clearly and specifically as possible, tell us about your complaint. Include pictures of problems that are visible.
(If you are having problems with both the mattress and the box spring, describe both sets of problems and indicate
which pertain to the box spring and which to the mattress.)
CUSTOMER SERVICE REQUEST FORM
(Please print the following information)
Name_____________________________________________________________________________________________
Street________________________________________City_____________________State_________Zip____________
Daytime Phone ( ) __________________________Evening Phone ( ) _____________________________________
………………………………………………………………………………………………………………………………..
(Please tell us which product(s) you are having a problem with:
Mattress ( )
Box Spring ( )
Both ( )
…………………………………………………………………………………………………………………………………
In order to accurately and quickly process your request, we will need you to fill in the following information from
the law tags of both your mattress and the box spring, even if you are claiming service on only one. Please locate
the law tags of both your mattress and box spring. (Law tags can be found attached to the foot of the piece).
If your law tag is missing, the manufactures warranty is voided.
If you do not use a box spring then please write in “None used”.
For Mattress
For Box Spring
Model Name
___________________________
___________________________
Size
___________________________
___________________________
Warranty
___________________________
___________________________
Date Made
___________________________
___________________________
…………………………………………………………………………………………………………………………………
Please indicate the date and the location of purchase.
For Mattress
For Box Spring
Date of Purchase
___________________________
___________________________
Dealer & Location
___________________________
___________________________
…………………………………………………………………………………………………………………………………
As clearly and specifically as possible, tell us about your complaint. Include pictures of problems that are visible.
(If you are having problems with both the mattress and the box spring, describe both sets of problems and indicate
which pertain to the box spring and which to the mattress.)
CUSTOMER SERVICE REQUEST FORM
Since making your purchase, how have you maintained and cared for your bedding and how frequently?
…………………………………………………………………………………………………………………………………
On the attached diagram, please indicate where the problem is and show any changes to the bedding since you
received it. For example, if there were tears or stains, show where and write the words ‘tear’ or ‘stain’, etc.
…………………………………………………………………………………………………………………………………
If your mattress has large body impressions, please measure the deepest one in the following manner: (1) place a
string tightly across the bed, (2) place the end of a ruler in the deepest point and note its depth.
Deepest impression ________________.
…………………………………………………………………………………………………………………………………
What is you bed frame made of?
Wood ( )
or
Metal ( )
…………………………………………………………………………………………………………………………………
Look at your bed frame and draw the locations of any supports on the attached diagram:
…………………………………………………………………………………………………………………………………
Do you use boards or other flat objects in between your mattress and box spring to increase the mattress firmness?
Yes ( )
No ( )
If yes, please tell us what you use:____________________________________________________
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Have you moved since buying your bedding? Yes ( )
No ( )
If yes, tell us the name of the mover you used, as well as the date of the move.
Mover ___________________________________________________________ Date ________________________
…………………………………………………………………………………………………………………………………
Have we replaced this bedding before? Yes ( )
No ( )
If yes, please indicate when and for what reason _____________________________________________________
………………………………………………………………………………………………………………………………
I represent that the information above is accurate and complete to the best of my knowledge.
____________________________________________________
_________________
Signature
Date
Thank you for filling out this form. Your completed request will be evaluated and a letter will be sent to you to inform you of
the results of our evaluation and our decision to inspect, replace, or repair your bedding, as applicable.
A COPY OF PROOF OF PURCHASE MUST BE INCLUDED WITH THIS FORM OR THE REQUEST WILL
NOT BE EVALUATED.
Please use these diagrams to identify where you have problems with your bedding.
MATTRESS TOP
BOX SPRING TOP
The frame supporting your mattress and box spring is important to the life of your product.
Describe your frame (indicate location of center legs, horizontal or vertical supports).
BED FRAME
Please return all completed pages and supporting doccumentation to:
Mattress City
Attention Warranty Claims
15205 S. Keeler
Olathe, KS 66062
Please allow 10 – 14 business days for response.
Phone: (913) 780-1065
Fax: (913) 780-2960
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