Order Report Form

Please fill out each question below within 24 hrs of the reciept of your order. Your request will be processed on the coming Friday and you will be notified of the outcome of your request via the email address you enter below. If you need further assistance please contact Rebecca Davis asm@easttexasfoodbank.org – 903-617-2060 or Irene Howard at ihoward@easttexasfoodbank.org – 903-617-2030. Thank you for serving hungry people!

Agency Number*
Please provide your agency number
Agency Name*
Please provide your agency name.
Reason For Report*
Multiple selections are allowed.
- Did not receive the product
- Product quantity was incomplete
- Product was unusable
- Product was damaged
- Poor quality
- Charged delivery fee for produce
Invoice #*
What is the invoice # (not the PO) you received product on?
Item # or Incorrect Fee*
What is the item # of the damaged / incomplete product or the produce delivery fee charged?
Quantity damaged or missing*
How many cases were damaged or missing?
Did you inspect your product upon pick up/delivery?*
- Yes
- No
Contact Name*
Please provide the name of the person we should contact regarding the issue.
Email Address*
Please provide the email address we should email regarding the issue.

East Texas Food Bank

Order Report Form

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