CUSTOMER ASSISTANCE FORM

INVOICE NO.

TODAY'S DATE

NAME

COMPANY

DEPARTMENT

ADDRESS

CITY

STATE

ZIP CODE

E-MAIL

TELEPHONE NO.

EXT.

FAX NO.

SHIPPING ADDRESS

NAME

COMPANY

DEPARTMENT

ADDRESS

CITY

STATE

ZIP CODE

PROBLEM WITH YOUR ORDER ï PLEASE CHECK BOX

YOUR ORDER WAS

 DAMAGED IN SHIPPING

YOUR ORDER WAS

 DELIVERED TO INCORRECT ADDRESS

YOUR ORDER WAS

 INCORRECT PRINT RECEIVED

GIVE A BRIEF DESCRIPTION OF THE PROBLEM