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
