OVERL
OFFICE OF THE ATTORNEY GENERAL
CONSUMER PROTECTION DIVISION
HOME BUILDER GUARANTY FUND CLAIM SUBMISSION FORM
LAST NAME FIRST NAME NAME OF BUSINESS YOU ARE COMPLAINING ABOUT
STREET ADDRESS STREET ADDRESS
CITY, STATE, ZIP CITY, STATE, ZIP
DAYTIME PHONE # EVENING PHONE # PHONE #
E-MAIL ADDRESS FAX # E-MAIL /WEB ADDRESS FAX #
DATE OF CONTRACT___________________________ AMOUNT CLAIMED ________________________
CHECK THOSE THAT APPLY:
Written notice of defect or other claim for loss has been sent to builder.
Builder has been permitted reasonable access to the property, during regular business hours, to inspect and correct
the alleged defect or other claim of loss.
Warranty Security Plan Exists. If Yes:
Claim was filed with plan
Claim was denied in full
Claim was denied in part
Other (explain): _________________________________________
Attach copies of the following documents to this claim form (Do not send originals.):
! Written notice of defect sent to the builder
! Documentation of attempts to permit builder access to the property to inspect and repair the damage, if any
! Contract of sale, including all addenda and any change orders
! Engineering, inspection or other expert reports, if any
! Photographs, videotapes, diagrams, etc., if any
! Warranty security plan claim, including all documents submitted by any party to the claim, evidence of any
recoveries in the claim, and the claim denial, if any
! Any other evidence in support of your claim
PLEASE DESCRIBE THE FACTS GIVING RISE TO YOUR CLAIM, IN THE ORDER IN WHICH THEY HAPPENED. IF POSSIBLE, PLEASE
IDENTIFY ANY INDIVIDUALS YOU DEALT WITH IN CONNECTION WITH YOUR CLAIM. (ATTACH ADDITIONAL SHEETS AS NEEDED):
Your Signature Date
PLEASE MAIL YOUR COMPLAINT TO THE OFFICE LISTED BELOW THAT IS NEAREST YOU.
Baltimore Office
Consumer Protection Division
200 Saint Paul Place
Baltimore, Maryland 21202
(410) 528-8662
Fax: (410) 576-7040
Eastern Shore Office
Consumer Protection Division
201 Baptist Street, Suite 30
Salisbury, Maryland 21801
(410) 713-3620
Fax: (410) 713-3621
Western Maryland Office
Consumer Protection Division
44 N. Potomac Street, Suite 104
Hagerstown, Maryland 21740
(301) 791-4780
Fax: (410) 791-7178
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