Company Name (required)

Account Number (if known)

Your Name (required)

Contact Email (required)

Contact Phone (required)

Product (required)

Reason for complaint (required)

Quantity Affected (required)

Batch Number (required)

All products have a batch number. Please refer to the label.

Expiry Date (required)

Delivery Date or Invoice No (required)

Attach images (we require an image of the product affected to allow us to fully investigate the issue)