<p> Service/Product Comment Form</p><p>Please use this form to report issues on products or services (positive or negative) related to any vendor, manufacturer, or distributor doing business with Multi Region Purchasing Co-op. Please provide as much information as possible and include any pictures taken of the product or packaging as necessary.</p><p>Co-op Member: Date: </p><p>Member Contact Name: </p><p>Name of Vendor/Distributor: Brand: </p><p>Product Name: Product Code:</p><p>Date Received: Date Used:</p><p>Production Date Found on Box Label: </p><p>Comments: </p><p>Have you reported this to the vendor/distributor rep? YES NO (circle or highlight one)</p><p>Vendor/Distributor Rep Name: Date Reported: </p><p>Co-op Member Signature: </p><p>Phone #: Email: </p><p>Fax or Email to: Keri Warnick Office use only: Fax: 972.348.1449 Date Rcvd: [email protected] Initials: </p>