Date of Purchase
1
Brand
The brand not repair under warranty
2
Appliance
This appliance is not repair under warranty
3
Required documents
Defect description
5
Claim type
Delivery way
municipality


Pick up address
information
Customer's Firstname
 
Customer's Surname
 
Phone No.
 
E-mail
 
Send messages to the customer (in customer's formate)

E-mail Do not send messages