Customer Complaint Intake Form

Intake form for capturing customer complaints, order issues, requested resolution, and follow-up details.

Customer Information

• Customer name
• Preferred contact email
• Preferred contact phone
• Preferred contact method

Complaint Details

• Date of complaint or issue
• Type of issue
• Order number or reference ID
  Enter the order or case reference if available. Do not include payment card details.
• Describe the issue
  Include what happened, when it happened, and any relevant context.
• Where did the issue occur?

Requested Resolution

• Requested resolution
• Additional resolution details
  Use this field if the customer wants a specific amount, replacement item, or other details.
• Desired timeline for resolution

Attachments and Follow-Up

• Supporting files
  Upload photos, receipts, screenshots, or other relevant documents.
• Additional notes
  Add any other information that may help with investigation or follow-up.
• Submit anonymously
  Select this if you do not want to provide contact details. Anonymous submissions may limit our ability to follow up.