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* 1. Personal Details:

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* 2. Product Details:

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* 3. What do you think of the quality of the product?

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* 4. Nature of your complaint:

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* 5. Describe the product defect:

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* 6. Description of allergy or skin irritation:

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* 7. Do you currently use any other Avroy Shlain products?

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* 8. How long have you been using the product?

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* 9. Packaging damages: 

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* 10. Describe  the packaging defect:

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