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General Inquiry Report a Product Issue

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Title

Mr. Mrs. Ms.

* First Name

* Last Name

* Address, City

* Postal Code

(Ex: A1A 1A1)

* Region

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* Email Address

Phone

Product Name

Retailer Name, Address, City

UPC/Barcode

(Consists of 12 Numbers please enter all)

Manufacturing Code

(Letters and numbers next to Best Before Date (REG #/Time Stamp))

Purchase Date

Best Before Date

* Comments

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