• 26 Mills Road Braeside VIC 3195 Australia

Adjustable Bed Concern Form

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  2. Adjustable Bed Concern Form

    Personal Information
    *Today's Date
    *First Name
    *Last Name
    *Email
    *Confirm Email
    *Phone Number (Primary)
    Phone Number (Secondary)
    *Home Address
    *City / Suburb
    *State
    *Postcode
    Purchase Details
    *Retailer Name
    *Store Location
    *Are you the original purchaser of the product? YesNo
    *Purchase Date
    *Do you have your receipt? (if no please contact place of purchase) YesNo
    Product information
    *Product Size
    *Product type / Functions
    *Have you read the terms and conditions of the guarantee? YesNo
    *Does the product have any stains or marks? YesNo
    *Please describe your concern
    Product images
    IMAGES MARKED WITH AN * ARE REQUIRED TO PROCESS CONCERN
    IMAGE REQUIREMENTS:
       File formats GIF, JPG & PNG
    *Upload receipt (receipt must show purchase date/retailer/receipt number/product name)
    *Upload condition photo
    *Upload issue photo (inside battery cover of wired power adapted)
    Upload additional photos 1
    Upload additional photos 2