1. Please indicate if a response is required.
  2. Reason for Email
  3. Adaptive Form Title
  4. First Name
  5. Last Name
  6. Email Address
  7. Confirm Email
  8. Contact Phone Number
  9. Address 1
  10. Address 2
  11. City
  12. State
  13. Zip Code
  14. ExtraCare® Card Number
  17. Phone Number Linked to ExtraCare Account
  20. Store Number
  21. Date of Store Visit
  23. Register Number
  24. Transaction Number
  26. Have you already contacted Customer Care about this issue?
  28. Description of Issue
  29. Origin
  30. Source Offer
  31. Email Source
  32. Submit

Customer Information

View back of card

Or

Transaction Information

View Example Receipt

If you have a receipt, please enter the following information:

Description of Issue

To protect your financial security, please do not enter any financial information in the notes. Should it be necessary to examine your purchase record(s), we will access that information by using your ExtraCare card (if you used it during your purchase) or by reviewing the information from the receipt. Please enter the appropriate information into one of those fields or contact Customer Service at 1-800-746-7287.