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  First Name*  
  Last Name*  
  Telephone Number*  
  Email Address*  
  Preferred Method of Contact  
  Product List  
  Other Product Name  
  In which state(s) did you make the purchase(s)?  
  Where did you make the purchase(s)?  
  When did you make the purchase(s) (even if approximate)?  
  Description of Problem Experienced  
  Efforts to Resolve  
  Did you contact anyone (e.g. manufacturer; retailer) to complain about the product(s)?  
  If yes, how did you complain, and what was the result of that complaint?  

After submitting the above form, an attorney from our team will contact you to discuss your individual experience with flushable wipes. Please note that by submitting the form, no attorney-client relationship has been established.