CoreOne - LCP

Please note the following fields are required: complaint type, your first name, last name, address, email, phone number, a brief description, product name, packaging type, and an acknowledgement statement. The form will not submit without this information.

* Complaint Type

Your Contact Information

* First Name

Middle Name

* Last Name

Suffix (Sr., Jr., etc.)

* Physical Address Line 1

Physical Address Line 2

* Physical City

* Physical State

Physical County

* Physical Zipcode

* Email

* Mobile Phone

Home Phone

* Briefly describe the nature of the complaint (Who, What, When, Where, How)

Product Information

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Product Purchased Date

Lot Number

Expiration Date

* Product Name

* Packaging

Weight

Units

Name of Distributor / Place of Purchase

Distributor Street Address

Distributor City

Distributor ZIP Code

Distributor State

Manufacturer Information

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Manufacturer Name

Manufacturer Street Address

Manufacturer City

Manufacturer State

Manufacturer Zip code

Additional Information

Animal Death

Quantity of Animal Deaths

Human Death

Injury

Sickness

Other

If applicable, please provide more details/descriptions regarding sickness and/or deaths.

Date of Occurrence

Add any relevant attachments in the Attachment section below.

Attachment

Complaint Document(s)

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Add Attachment(s)

The information given above is true to the best of my knowledge and belief. I authorize the Tennessee Department of Agriculture to use this information in conducting this investigation.

* I attest the statement above is true.

Yes

Submission Date

Please note the following fields are required: complaint type, your first name, last name, address, email, phone number, a brief description, product name, packaging type, and an acknowledgement statement. The form will not submit without this information.

Tennessee Department of Agriculture

Consumer and Industry Services

Online Consumer Complaint Form

Your Contact Information

Product Information

Manufacturer Information

Additional Information

Add any relevant attachments in the Attachment section below.

NOTE: After selecting Submit, if "Please Wait" does not replace the submit button, then required information is missing.