Empire Merchants CS Form – Contact Pages

Questions or Concerns?

Customer Service Request Form

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 *

Action *

Invoice # *

Invoice Date *

Item # *

# of Broken Bottles *

Item # shorted *

Quantity shorted *

Reason *

Lot #

Action *

Invoice # *

Invoice Date *

Item # *

Quantity (cases or bottles) *

Item # shorted *

Quantity shorted *

Action *

Invoice # *

Invoice Date *

Item # Billed For *

Quantity (cases or bottles) *

Item # received *

Quantity *

Action *

Invoice # *

Invoice Date *

Item # Billed For *

Quantity *

Action *

Invoice # *

Invoice Date *

Item # Shorted *

Quantity Shorted *

Action *

Invoice # 1*

Invoice Date 1 *

Invoice # 2 *

Invoice Date 2 *

Action *

Invoice # *

Invoice Date *

Item # *

Invoice # *

Invoice Date *

Invoice # *

Invoice Date *

Invoice # *

Invoice Date *

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