Personal details:

Name & Surname

Address

E-mail

Telephone number

Information about Company and product:

Company name & address

Product

Order number

Distributor‘s ID number (if known)

Incident details:

The date and details of the incident

List the amount and cost of product, if relevant, include invoices or other supporting documents

Have you tried to resolve the matter with the distributor or company?

Any responses the other parties have made regarding the matter