| Complaint date: |
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| Sort of reagent: * |
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| Name and type of reagent: * |
e.g. BLT FOSFOR LIQUID 250 |
| Batch number of reagent: * |
e.g. 304311 |
| Catalougue code of reagent: * |
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| Expiration date: * |
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| Complained amount: * |
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| Complaint Event Day: * |
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| Distributor / User: |
| Company name: * |
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| Address - street, number: * |
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| Address - city, postcode: * |
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| Address - state: * |
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| Address - phone: * |
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| Your e-mail address: * |
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| Distributor name:(if user complaints) |
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| Complaint reason: *(max 508 characters) |
Deatiled description, if measuring data or pictures available please add them below.
Write number of bad reagents and their batch number, type of used instrument, used control and calibration materials
including their batch number
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| Attachments:(max 5 files, max 15MB/file) |
If you have any images, scanned documents, videos etc. attach them here.
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