Claim Form
Part 1
Customer Service Dept.
*
Please Select
Ali Henry
Brandon Winn
Daniela Vasquez
Dawn Turner
Jamie O'Daniel
Karah Plagens
Kylie Sark
Jessica Anderson
Adrienne Johnson
Stacy Bridges
Rena Wilkerson
Sierra M. McClure
Enter your email address
*
example@example.com
E-mail
Please Select
ahenry@vincentprinting.com
bwinn@vincentprinting.com
dvasquez@vincentprinting.com
dturner@vincentprinting.com
jamie@vincentprinting.com
karah@vincentprinting.com
ksark@vincentprinting.com
rena@vincentprinting.com
Customer
*
Account #
*
Non-conformity:
*
Please Select
Missing Extension
Missing Hardware
Missing Package
Package Arrived Damaged
Package Arrived Late
Poor Quality -Clear Coat
Poor Quality -Color
Poor Quality -Fading
Poor Quality -Finishing
Poor Quality -Ink
Poor Quality -Material
Poor Quality -Print
Received Product Damaged
Wrong Color
Wrong Creative
Wrong Finishing
Wrong Freight Cost
Wrong Product
Wrong Production Cost
Wrong Quantity
Wrong Shipping Address
Wrong Size
Wrong Substrate
Other
Claim Type
*
Quality
Service
Explain customers claim (according to the customer)
ReadOnly TextBox
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Claim Form
Part 2
Resolution
*
Credit
Replace
Have you requested the product be returned?
*
Yes
No
Original Invoice #
*
Original Invoice Date
/
Month
/
Day
Year
Date
Original MO#
Claim Order #
Claim Order Amount $
Credit Amount $
Explain why this resolution was decided:
Have we jeopardized our relationship with the customer?
Yes
No
Supporting Documentation
Upload a File
Upload documents that can back up the claim.
Cancel
of
Track Claim
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Claim Statement
CCS/AC
Check any factors that may have been contributors (multiple can be checked)
*
Product Design
Manufacturing
Quality
Product Testing
Planning
Maintenance
Service
Training
Communication
Estimating
Purchasing
Logistics
Management
Staffing
Customer
How did the non-conformity occur?
Is there anything that could have been done differently? If so, explain:
Supporting Documentation (optional)
Upload a File
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Claim Statement
Department Manager
Department Manager
*
How did the non-conformity occur?
Is there anything that could have been done differently? If so, explain:
Has any preventive measures been put in place? If so, explain:
Supporting Documentation (optional)
Upload a File
Cancel
of
Track Claim
DM E-mail
Submit
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Claim Statement
Quality Manager
Quality Manager
*
How did the non-conformity occur?
Is there anything that could have been done differently? If so, explain:
Has any preventive measures been put in place? If so, explain:
Supporting Documentation (optional)
Upload a File
Cancel
of
Track Claim
QM E-mail
Submit
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Claim Statement
Plant Manager
Plant Manager
*
How did the non-conformity occur?
Is there anything that could have been done differently? If so, explain:
Has any preventive measures been put in place? If so, explain:
Supporting Documentation (optional)
Upload a File
Cancel
of
Submit
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Claim Disposition
Disposition by
*
Type a question
Comments
Signature
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Credit Authorization
Authorized by
*
Comments
Signature
Submit
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Credit Note
Closed By:
*
Actions/Notes:
*
Submit
Should be Empty: