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Name*
Street Address
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Product Lot Code #*
The Product Lot Code typically appears near a product's expiration date on the product packaging. Please provide all the letters and numbers that you see. Examples are shown below.
Product UPC #*
Product UPC = a 12 numerical digit code uniquely assigned to a retail product unit. An example image is shown below.
Product Expiration Date*
If applicable, please provide any information about the product's expiration or best-by date from the product packaging.
Name of store where product was purchased
Please provide the complete name of the store where you purchased the product in question.
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