Survey - z_2015 - AR Customer Complaint Form

Order and Product Quality Report Form

Please use this form to report when orders received are not as expected or when product is considered unusable.

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Question - Required - Who is completing this form?

Question - Not Required - If Foodshare staff, please provide your name:

Contact Information:

Question - Not Required - Agency Name:

Question - Not Required - Foodshare ID#:

*

Question - Required - Contact Name:

Question - Not Required - Contact Title:

*

Question - Required - Contact E-mail:

Question - Not Required - Contact Phone:

Please tell us about your issue:

If you are reporting more than one issue, please select 'other' below, and describe in the corresponding field.

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What type of issue are you reporting?

(Select one of the available choices or enter a different value.)
Question - Required -

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Order received through:

(Select one of the available choices or enter a different value.)
Question - Required -

Please complete the following using the invoice received with your order:

For issues with multiple orders or multiple items on an individual order, please use the additional fields provided.

Question - Not Required - Invoice #:

Question - Not Required - Date order was received:

Month

Day

Year

Question - Not Required - Product description (if specific product issue):

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Product reference # (if specific product issue):

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Question - Not Required - Invoice #:

Question - Not Required - Date order was received:

Month

Day

Year

Question - Not Required - Product description ( if specific product issue):

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Product reference # (if specific product issue):

.

Question - Not Required - Invoice #:

Question - Not Required - Date order was received:

Month

Day

Year

Question - Not Required - Product description (if specific product issue):

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Product reference # (if specific product issue):

Question - Not Required - Desired corrective action or Foodshare response:

*

Question - Required - Please send any photos of affected product that might be helpful to Foodshare Warehouse Manager, Rich Hiscox (rhiscox@foodshare.org):