Complaint form

COMPLAINT FORM

Date of submission: ……………………

COMPLAINT FORM (NON-CONFORMITY OF GOODS WITH THE CONTRACT)

Customer details:
Name and surname / company: …………………………………
Address: ……………………………………………………
E-mail: ……………………………………………………
Telephone: ……………………………………………………

Order details:

• Order number: ……………………………………

• Date of purchase: ……………………………………………

• Name of the product/products: ………………………………

• (for devices) Model / memory / color: ………………

• Description of the condition in the offer (A/B/C): …………………………

Description of the problem (when it occurred, how it manifests itself):
………………………………………………………………
………………………………………………………………

Date the problem was discovered: ………………………………

Customer Request (check):
☐ repair
☐ exchange
☐ price reduction
☐ refund

Attachments (check):
☐ photos
☐ video
☐ other: ………………………………

Seller details:
iSeller – Daryna Vodolazkina
ul. Żurawia 32/34, apt. 29, 00-515 Warsaw
e-mail: info@iseller.com.pl , tel. +48 732 554 136