New complaint

First Name *

Last Name *

Email *

Phone Number *

Street

Number

ZIP Code

City

Order Number *

Date of purchase

Date of receipt

 Date of detection of the defect *

Product name *

Price

Customer expectations Free repair of goods Replacement of goods for a new one Lowering the price of the good  Withdrawal from the contract and refund of the amount paid Undefined

 Bank account number

Store name Mensura

Bill number

* Required