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Run: Customer Complaint Intake Form

Customer Complaint Intake Form template for capturing complaint details, related order or service information, and the resolution the customer wants. Use it ...

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Customer Information

Customer name

Optional if you prefer to submit anonymously or if your organization already has a case reference.

Preferred contact email

Used only for follow-up on this complaint.

Preferred contact phone

Optional alternate contact method for follow-up.

Submit anonymously

Select this if you do not want to provide identifying information. Anonymous submissions may limit our ability to follow up.

Yes No N/A

Complaint Details

Date of complaint (required)

When the issue occurred or was first noticed.

Issue category (required)

Brief summary of the issue (required)

One short sentence describing the complaint.

Detailed description (required)

Include what happened, who was involved, and any relevant context.

Impact level (required)

How severely did this issue affect the customer experience?

Order or Service Details

Is this complaint related to an order? (required)

Order number

Enter only the order reference needed to investigate.

Purchase date

Service or account reference

Use this for service, subscription, or account-related complaints.

Requested Resolution

Requested resolution (required)

Additional resolution details

Use this to explain the preferred outcome in more detail, if needed.

Preferred follow-up method

Attachments and Follow-Up

Supporting files

Optional screenshots, receipts, photos, or other relevant documents.

Additional notes

Include any other information that may help with review or resolution.

I consent to being contacted about this complaint

By submitting contact details, you consent to being contacted for investigation and resolution of this complaint.

Yes No N/A

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Email (required)

Your name (optional)

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