{exp:freeform_next:submissions search:unique_hash="{segment_5}" form="{segment_3}" limit="1" orderby="date" sort="desc"}

We've received your submission.

Please print this page and include it with your shipment. A copy of your information has also been emailed to you at {submission:email:value}.

If you have any questions about the product withdrawal, please contact us at withdrawal@smith-root.com.

Contact Information

{submission:name:value}
{if submission:org:value} {submission:org:value}
{/if} {if submission:tel:value} {submission:tel:value}
{/if} {submission:email:value}

Pick Up Address

{submission:street_address:value}
{submission:city:value}, {submission:state:value} {submission:zip:value}
{submission:country:value}
Equipment In Shipment
Equipment Serial Number
{submission:recall_equipment:value} {submission:serial_number:value}
Additional Information
{if submission:additional_information:value} {submission:additional_information:value} {if:else} None supplied. {/if}
{/exp:freeform_next:submissions}