|
Contact Details |
Title |
|
Contact Name |
|
|
|
*Business
Name |
|
|
Street or Postal Address |
Address 1 |
|
Address 2 |
|
Suburb, Town, City |
|
State, County, Province |
|
Zip, Postal Code |
|
Country |
|
|
|
Email |
|
Telephone
*Facsimile |
|
|
|
Customer Status |
|
|
|
|
Your Complaint |
|
Please provide a clear and concise description
of the problem
|
|
|
|
*On which date did this
first occur |
|
|
|
|
|
What do you feel caused the problem?
|
|
|
|
*Have you discussed
this with any of our staff?
|
|
|
|
*What outcome would
you be happy with?
|
|
|
Preferred contact method |
|
|
|
|
|
|
|
|
*Optional
|