Complaint form

Form for reporting a defect

Address for communication: Mária Lazarová, Žitavany, Žitavská 175/17, 95197, Slovak Republic

Customer

CustomerName and surname:

Address:

Telephone number/email address:

Complaint product/service

Number of proof of purchase or warranty certificate:

Name:Date of purchase:

Accessories:

Description of defect:

____________________________________________________________________________

I propose that my complaint be handled in the following way /tick the required/:□Exchange of goods □ Repair of goodsIn case the complaint is handled by refunding the money and if you wish to send the money to the bank account, please provide its number:
On ..................................... date: …………………
............................................Customer's signature