Contact

Name

Product Name Expiration Date on Package ^{(Stamped on the side of the box next to the barcode)}

Lot # ^{(Located on product pouch inside the box
will start with the current year e.g., 20_ _ _ )}

Est # ^{(Located on product pouch inside the box
will start with #P4_ _ _ _)}

Store Where Purchased Store Address

Store City

Store State

Message