Reagent complaint

Reagent complaint
* required field
Complaint date:
Sort of reagent: *
Name and type of reagent: * e.g. BLT FOSFOR LIQUID 250
Batch number of reagent: * e.g. 304311
Catalougue code of reagent: *
Expiration date: *
Complained amount: *
Distributor / User:
Company name: *
Address - street, number: *
Address - city, postcode: *
Address - state: *
Address - phone: *
Your e-mail address: *
Distributor name:(if user complaints)
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
Attachments:(max 5 files, max 5MB/file)
If you have any images, scanned documents, videos etc. attach them here.