Part I

Twitchell

QSR-T855-100

Rev. 24, 10/30/19

Customer Feedback Report

Control #: *

* Indicates required field

Date: *

Report prepared by: *

Customer Service Rep: *

Customer Contact: *

Company Name / Location: *

Sales Rep or Other: *

Phone Number: *

RMA/Credit Requested: *

Yes No

Invoice Number(s): *

Business Division: *

Customer Item # x width: *

Twitchell Item # x width: *

Quantity/Units: *

Nature of issue: *

Details: *

Customer Comments: *

*Does the customer require a SCAR or 8-D? *

Yes No

If so, forward to Quality Assurance!

Submit

QSR-T855-100 Customer Feedback Report