Whatever the reason, we are always eager to hear from our clients.

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Customer Phone: *

Customer Address: *

Apt, suite, etc.

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Contact Name: *

Contact Position: *

Invoice Number: *

Product Number: *

Product Description: *

Complaint, Comment, Compliment Date: *

Complaint, Comment, Compliment Taken By: *

Complaint, Comment, Compliment Details: *

First Response Corrective Action: *

Suspected Cause: *

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What steps should be considered to avoid a repeat of the problem? *

Date:

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