Complaint Form Customer Information Name Address Address Address 2 City/Town ZIP/Postal Code Home Phone Business Phone Email Fax Product Information Date Code Purchase Date Purchased At Storage Temperature - None -ColdRoom Temperature Brand - None -Steam Whistle Beau'sMTVNew BelgiumPhilips Packaging Type (bottle, 437 ml, keg etc.) Complaint Information Bottle/Can Complaint Bottle/Can Complaint Information Main Issue Broken Bottle Flat Haze Faulty Carton Foaming Off Taste Faulty Crown/Seal Foreign Material Other… Enter other… Package Size 6x341ml 12x341ml 24x341ml 1x500ml 24x500ml 6x355ml 10x355ml 24x355ml Number of Containers Returned Keg Complaint Keg Complaint Information Main Issue Faulty Keg/Seal Flat Foaming Foreign Material Haze Off Taste Other… Enter other… QC Red Keg Cap Number Keg Type 20L 30L 50L (stainless) 50L (rubber) Pushed With Air CO2 Beer Gas Amount of Beer Returned (%) Comments (Was the problem noticed from the beginning?)
