Please Complete This Form

 

Product Feedback
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If you have purchased Kooka Brotha's products and wish to forward any feedback: have specific questions or are experiencing problems with certain products, we would like to hear from you.
Please complete your details in the spaces below 

  Full Name		
  Name of Establishment	
  Type of Establishment	
  Telephone		  Facsimile   
  What is the best time for someone to call you ?	      
  Your email address	
  Product Name		 Date of Purchase   


  Briefly describe the nature of your feedback or the difficulties that you
  have been experiencing in the space provided below 

			

  Could you please supply the information that appears on the bottom line
  of the product label, which is on the top of the product box (inner).

  Please include the Best-if-used-by-date from the bottom left corner of the
  label and the 6 digit code from the right bottom corner of the same label.

  Best if used by date	  Six digit code

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