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Product Defect Report Form
Please fill the form below
Name:
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Company:
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Phone:
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Invalid phone number.
The value must be less than or equal to 20
EMail:
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Please enter valid email address
Product Details
Name of Product:
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Batch No.:
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Date Purchased:
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Date format is invalid, please check it again
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Total Number of Items:
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The value allows only numbers
Invalid number!
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Number of Faulty Units:
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The value allows only numbers
Invalid number!
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
How was the product secured in place:
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Details of the defect observed (please provide as much information as possible).:
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Please insert any photos of the product that you think may be or totally defected.:
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Any additional message or comments:
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