(This is not a Credit Request Form)
| TYPE
OF FEEDBACK (a
all that apply): __Price/Billing __Delivery/Shipping __Service __Product Quality __Product Availability __Other _______________________ |
OFFICE USE ONLY: Action Date: ___________ By: _________ Action Taken: _________________________________ _________________________________ _________________________________ |
Customer Name:
_______________________________ Customer #: ________________________
Your Name:_________________________________ Daytime Phone:
(___)____________________
Address:
________________________________________________________________________
Invoice #: _____________ Delivery Date:___/___/___ Route/Stop:
___________________________
Subject of Feedback:
______________________________________________________________
_______________________________________________________________________________
Feedback Attributed To:
____________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________ Today's Date:
____________________
Reply Requested: __YES
__NO (explain why) _________________________________________________________
Send to: Member Services, North
Farm Cooperative, 204 Regas Road, Madison, WI 53714
Toll-Free Fax: 1-888-632-3276 Local Fax:
1-608-241-0688