Complaint form

Do you have a problem with one of our products? Please fill in this form. We’ll contact you with the next steps and if we have any questions. Thank you

Section 1: Customer information (end-user)


Office name:
Contact name for complaint:
Position:
Adress:
City:
Postal code:

Email:

Section 2: Dealer

Company:
Contact Person (representative):
Address:
City:
Potal code:
Phone:
Email:

Section 3: Order information

Product: (Please make one complaint per product)
Lot number:
Product number:
Invoice number:
Quantity (box/case) :
Customer order date (yyyy-mm-dd) :

Section 4: Questionnaire

Have any of the following occurred while using the product?
(hold down the CTRL button to select several answers) :

Problem observed with the product:
Is this the first use of the product?
Frequency of use
Expiry date of the product:
History of product storage and conservation condition?
Are there any supporting documents, labels or pictures?
Comments:
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