Request for Reimbursement

UHP will not be able to consider a reimbursement without a detailed service report, and reimbursement may only be considered if it can be determined UHP’s contractual rights were not prejudiced as a result of the unauthorized work. UHP may not reimburse the homeowner for labor or materials, or other services not authorized or supplied by UHP. If work was performed without UHP’s authorization and you would like to submit a request for reimbursement, please complete the form below. Be sure to explain the circumstances in detail and attach copies of the service reports/work orders, paid invoices, and other supporting documents.

Contractor Company Name

Address of the contractor:

Street Address Address Line 2 City State ZIP Code

Contractor's phone number:

Email

Homeowner Name*

First Last

Homeowner Phone Number

Homeowner Email

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Warranty Contract #

Please attach copies of any supporting documents for our consideration. Helpful documents may include, but are not limited to, the contractor’s Certificate of Liability Insurance form, any service reports, work orders, and paid invoices. If you do not provide a service report, UHP cannot consider a reimbursement.*

Max. file size: 100 MB.

Please explain the circumstances in detail and provide us with any other pertinent information for our consideration:*

Did you submit a service report from a licensed contractor stating what was wrong?*

Yes
No, (If you do not submit a service report or diagnosis, you will not be able to submit the request for reimbursement.

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