Customer Complaint Submission Form

Customer Complaint Form

Customer Complaint Submission.

Your Name(Required)

Person completing this form. First and Last.

Customer Full Name(Required)

First and Last

Company Name(Required)

Email(Required)

Phone Number

Street Address(Required)

City(Required)

State(Required)

Country(Required)

Which Distributor did you purchase through?(Required)

Distributor Rep Name

Full Name.

Distributor Rep Email

Part Number(Required)

If multiple, please list seperated by a comma.

Lot Number(Required)

This can be found on the product label. This is also listed on the rack if this issue is for a pipette tip product.

Description of the Issue(Required)

Please describe the issue in as much detail as possible.

What instrument are you using?

Please include the manufacturer, type of equipment and model. Example: Rainin LTS electronic 8-channel 20uL pipette.

Quantity with defect(Required)

Unit of Measure(Required)

For example packs, cases, bags, etc.

Is any of the affected product available to be sent to us for evaluation?(Required)

Replacement Required?(Required)

Please submit any photos or videos of the issue to CSR@biotix.com or directly to your Biotix sales representative.