Customer Complaint Form

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C C u u s s t t o o m m e e r r C C o o m m p p l l a a i i n n t t F F o o r r m m
1 1 . .
C C u u s s t t o o m m e e r r d d e e t t a a i i l l s s
Title (Mr, Mrs, etc) Family name (surname)
Given names
Street address
Suburb
Postcode
Home telephone number
Business telephone number
Mobile telephone number
Email address (if applicable)
2 2 . .
D D e e t t a a i i l l s s o o f f o o t t h h e e r r p p e e r r s s o o n n o o r r s s u u p p p p l l i i e e r r i i n n v v o o l l v v e e d d i i n n t t h h i i s s c c o o m m p p l l a a i i n n t t
Name
Street address
Suburb
Postcode
Home telephone number
Business telephone number
Mobile telephone number
Email address (if applicable)
3 3 . .
D D e e t t a a i i l l s s o o f f g g o o o o d d s s o o r r s s e e r r v v i i c c e e s s s s u u p p p p l l i i e e d d t t o o t t h h e e c c u u s s t t o o m m e e r r
Date of purchase or service
/
/
Description of the goods or service including make, model, type of service, purchase method, etc.
4 4 . .
D D e e t t a a i i l l s s o o f f w w h h a a t t t t h h e e c c u u s s t t o o m m e e r r c c o o m m p p l l a a i i n n t t i i s s
O O f f f f i i c c e e u u s s e e o o n n l l y y
Complaint received by
Date received
In person
/
/
In writing
Action taken or required
Date action completed
Signature
/
/

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