Customer Records

This purpose of this form is to record a concern or incident regarding customer behavior / customer interactions that may break L.O.C policy.

Customer Name

First Name

Last Name

Customer Phone

(###)

###

####

Customer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Incident

MM

DD

YYYY

Description of Incident

Briefly describe the incident & how the customer violated the Membership Rules / Terms & Conditions.

Action Taken

Form of Communication

In what form of communication was the action issued?

Team Member(s)

List all team members involved in the incident and its resolution.