lape

Date of Incident *

Name or Company Name *

1. IDENTIFICATION OF THE COMPLAINING CONSUMER

Applicant's name *

Home *

ID or immigration card *

Phone / E-mail *

Father or Mother

2. IDENTIFICATION OF THE CONTRACTED GOOD

Guy *

Claimed Amount *

Description *

3. DETAILS OF THE CONSUMER'S CLAIM AND ORDER

Is it a claim or complaint? *

Detail *

Order *

4. OBSERVATIONS AND ACTIONS ADOPTED BY THE SUPPLIER

Date of Communication of The Response:

Observations

* Required fields