Customer Complaint Form
Thank you for shopping at Brand Name Electronics. We sincerely apologize for any problems that you encountered during your visit. Please fill in the information below to help us understand what went wrong so that we can make things right.
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First Name
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Last Name
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Address 1
Address 2
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City
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State
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Postal Code
Phone
Email Address
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Store Location
Chicago
Denver
New York
San Diego
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Date of Visit (MM/DD/YYYY)
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Please describe what happened. Be as detailed as possible and write as much as you would like.
What do you feel would be a fair resolution to the situation that occurred?
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Indicates Response Required