Submit a Customer Complaint

To be used to record customer product complaints, etc.

Date

Customer Name(Required)

First Last

Customer Email(Required)

Customer Phone(Required)

Customer PO or LightCorp Order Number:

Part Number(s) Affected:

Part Description

Quantity

Describe the Issue Here:

Upload an Image of the Issue (optional)

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 2 MB, Max. files: 3.

Describe any steps taken to try to resolve the issue:

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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