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 WorkTelephone Number*Email* Enter Email Confirm Email Retailer*Purchase Date* (if unsure, please provide approximate date)Proof of Purchase Drop files here or Accepted file types: jpg, jpeg, gif, png, bmp, pdf. Upload image of receipt or invoice for proof of purchase or provide details below if image not availableReason Proof of Purchase Not Attached (if applicable) Save and Continue Later Brand*BabydanBednestBumblerideCalafantChildhomeDone by DeerKipodLeanderLinea by LeanderMeelightMilaniwoodMioplayMoover ToysTrollProduct*Colour*Model / YearFault Description*Item broken or damagedMissing part or hardware requiredWrong item has been sentAssembly issuesPhoto of issue Drop files here or Accepted file types: jpg, jpeg, gif, png, bmp, pdf. 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 belowVideo of issueAccepted file types: avi, mpeg, mpg, mp4, wmv.Please attach video. Upload video of up to 128Mb in AVI/MPEG/MP4/WMV format. Parts required if possible to identify – from manualEmailThis 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.