DATE______________

CUSTOMER____________________________________________________

ADDRESS_____________________________________________________

_____________________________PHONE___________________

MERCHANDISE PROBLEMS: DELIVERY PROBLEMS:

ORDER NOT FILLED BAD ADDRESS

DEFECTIVE MERCHANDISE CUSTOMER NOT IN

REPAIR PROBLEM DELAYED/LOST IN TRANSIT

WRONG MERCHANDISE SOLD DAMAGED IN TRANSIT

AMOUNT CHARGED IN ERROR MDSE. MISSING IN PACKAGE

CREDIT/REFUND NOT ISSUED OTHER___________________

OTHER___________________ ________________________

REMARKS:

DISPOSITION: