Product Issue Form Step 1 of 2 - Customer Details 50% Completed By*RetailerCustomerDanish By DesignDate* Name* First Last Address* Street Address Address Line 2 Suburb State Post Code No PO BoxesIs this address:*My HomeMy WorkCompany Name (if applicable)Telephone Number*Email* Enter Email Confirm Email Store Purchased From*Purchase Date* (if unsure, please provide approximate date)Proof of Purchase Upload image of receipt or invoice for proof of purchase or provide details below if image not available Click on the "Plus" icon to upload more than one file (max 5).Reason Proof of Purchase Not Attached (if applicable) Save and Continue Later Brand*BabydanBednestBumblerideCalafantChildhomeDone by DeerKipodLeanderLinea by LeanderMeelightMilaniwoodMioplayMoover ToysTrollProduct*Colour*Model / YearReason for contact / claim – please provide us with as much information as possible*Photo of issue Please attach images. Upload up to 5 images of up to 10Mb each in JPG/PNG/BMP/GIF/PDF format. If you have video, upload it via the field below. Click on the "Plus" icon to upload more than one file (max 5).Video of issuePlease attach video. Upload video of up to 128Mb in AVI/MPEG/MP4/WMV format. Parts required if possible to identify – from manualPhoneThis field is for validation purposes and should be left unchanged. Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.