Customer Concern Form

If urgent, please immediately call Jason Stamp, with Jeff Flenniken and/or Bryan Cassill as back-up.

* Denotes Required Field

Please fill out the information below.

DSM NAME & NUMBER

DSM Name (other)

Insert N/A if you don't have that information

DSM EMAIL ADDRESS

CUSTOMER NAME

Customer Name (other)

Insert N/A if you don't have that information

DATE CONCERN WAS RECEIVED

PRODUCT

PRODUCT (OTHER)

DATE CODE

Insert N/A if you don't have that information

Qty

Insert N/A if you don't have that information

BAG#

Insert N/A if you don't have that information

CONCERN DESCRIPTION

Insert N/A if you don't have that information

CREDIT REQUIRED

NOTES (INCLUDE WHERE CREDIT SHOULD COME FROM)

Insert N/A if you don't have that information