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Store Complaint Form


Please note your Name and Telephone number are confidential.









Date submitted:      


Full name:


Email:


Telephone:


Name of store:


Street address of store:


City/Town/Village where store is Located:


Zip Code:


Date item purchased/Date at store:      


Describe item purchased (name of item and weight):


Do you have a receipt:


Did you speak to the clerk or manager at the store:


Describe complaint:


Maximum number of characters: 2,000


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