Please fill out one the form below and your request will be directed to the correct department. Empire Merchants will respond within two business days.
Submitted By *
Email: *
Customer Number *
Order Number *
Customer Phone Number
Problem * BreakageUnsaleableOrdered Wrong ItemShort on truckQuantity Discount CreditDelivered Wrong ItemMis-priced itemInvoice DisputeRequest Delivery Instructions or ChangesRequest Copy of InvoiceRequest Copy of StatementRequest Copy of Credit Memo
Action * Exchange (Full Case Only)Ship to Complete
Invoice # *
Invoice Date *
Item # *
# of Broken Bottles *
Item # shorted *
Quantity shorted *
Reason * Packaging or LabelMerchandise
Lot #
Action * Exchange
Quantity (cases or bottles) *
Item # Billed For *
Item # received *
Quantity *
Action * Pickup for Credit
Action * Ship to Complete
Item # Shorted *
Quantity Shorted *
Action * Re-price item for Credit
Invoice # 1*
Invoice Date 1 *
Invoice # 2 *
Invoice Date 2 *
Time Code * Early AM--Code 18Before 11AM--Code 07After 10am--Code 41Before 1pm--Code 52After 1pm--Code 34After 3pm--Code 05
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