ANZ Pharma Wholesalers Claim Request

ANZ Pharma Wholesalers Claim Request

To help us fulfill your request, please complete this form as completely as possible. A representative will respond within 12 hours. At the bottom there is an option for you to receive a copy via email of this form for your records, please tick the box for this option.

Date Submitted*

Customer*

Please provide your Business Name.

Customer ID*

Please provide your Customer ID.

Invoice No*

Please enter the invoice you received the goods on.

Goods Received Date *

Reason for Claim*

Select

Claimed Product*

Please list the product and quantities that are being claimed Eg ANZ12345 ANZP HAND SANITIZER 50ML 1 Unit/12 Pack/4 cases

Claimed Product (ANZ Code)*

Product Expiry Date/Batch Number*

Customer Return

Sales Rep Return

Sales Rep Names

Select or enter value

Additional Information

Please provide any additional information to assist with this claim. (If your claim is freight damage, please confirm whether you have noted the damage on the POD docket)

File Attachments*

If you have photos of the damage and short expiry to submit, or other correspondence to assist you.

Drag and drop files here or

Your Contact Name*

Who should we contact about this claim?

Customer Phone*

What is your phone number?

Customer Email*

Please provide a valid email address for correspondence

Send me a copy of my responses

Email address

URGENT

Terms & Conditions: The customer must inspect the goods promptly following delivery. No claims will be accepted unless made within 7 days of delivery.*

Steps Taken

Company Name:

Send me a copy of my responses

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