SECTION 1: CUSTOMER & ORDER INFORMATION 

• Full Name: ________________________________________________ 

• Account ID / Email: _______________________________________ 

• Order ID (Found in App/Email): _____________________________ 

• Date of Pickup: //2026 | Date of Delivery: //2026 

SECTION 2: NATURE OF THE INCIDENT 

Please check the category that most accurately describes your concern: 

• [ ] Cleaning Quality: (e.g., Lingering stains, odors, poor folding/pressing) 

• [ ] Physical Damage: (e.g., Tears, shrinkage, hardware failure, color bleeding) 

• [ ] Missing Item: (e.g., Specific garment not found in the delivered bag) 

• [ ] Logistics Issue: (e.g., Missed window, driver conduct, unattended delivery issue) 

• [ ] Billing/Pricing: (e.g., Incorrect weight, unrecognized surcharge, promo code error) 

SECTION 4: DETAILED STATEMENT OF ISSUE 

Please describe the incident in detail. For damage claims, please specify the exact location of the damage on the garment. 

SECTION 5: EVIDENCE & DOCUMENTATION 

• [ ] Photographs Attached? (Required for Damage/Quality claims. Attach 1 wide shot and 1 close-up of the affected area.) 

• [ ] Proof of Value Attached? (Required for claims exceeding $100.00. Attach receipt or bank statement.) 

• [ ] Original Washables Tags Attached? (Must remain on the garment for rewash/damage claims.) 

SECTION 6: PREFERRED RESOLUTION 

• [ ] Rewash/Re-press: (Priority correction at no cost) 

• [ ] Service Credit: (Applied to your Washables digital wallet) 

• [ ] Refund: (Returned to the original payment method) 

• [ ] Liability Claim: (Formal investigation for depreciated value settlement) 

SECTION 7: CUSTOMER DECLARATION 

By signing below, I certify that the information provided is accurate and that I have reported this incident within the mandatory 24-hour window following delivery. I understand that my claim is subject to the Liability Limitation Policy (WASH-LEGAL-LIAB-2026-014) and that an investigation (including video review) may take up to 7 business days. 

Name:_________________________________ 

Signature: _________________________________ Date:        /      /20__