2-10Warranty

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

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.

Homeowner Signature:

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.

Homeowner Signature:

Date:

HBW_305_061713

WARRANTYADMINISTRATION@2-10.COM | FAX: 303.306.2239