Customer Complaint Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Product Category
*
Please Select
Beverage
Candy
Jelly
Syrup
Other
Item Name and UPC
*
Enter product name/flavor and barcode
Affected Quantity
*
Lot Number
*
Ex. expiration date, sell by date
Purchase Location
*
Include purchase date, store name and City/State
Complaint
*
Please give us details
Add Product Images
Browse Files
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Submit photos of the issue and date on the package
Cancel
of
Submit
Should be Empty: