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Customer Complaint Form

Customer Details

Surname  
Given Name  
Company  
Street Address  
Suburb  
Postcode and State  
Telephone Number  
Fax Number  
Mobile Number  
E-mail Address  

Details of Goods or Services Supplied to the Customer

Date of Purchase or Service
 
Description of Goods or Service including Make, Model, Type of Service
 
 

Details of what the Customer Complaint is

 
 
 
 
 
 

Office Use Only

Complaint Received By Date
   
Action taken or Required
 
 
 
 
 
Date Action Completed Signature