نموذج شكوى العملاء

Device Name*

Please enter device name.

Device Model*

Please enter device model.

Device ID Number*

Please enter device ID number.

Device Serial Number*

Please enter device serial number.

Device Manufacturer*

Please enter device manufacturer.

Device Representative Company*

Please enter device representative company.

Treatment Center / Device Installation Location*

Please enter treatment center / Device installation location.

Name of Responsible Person*

Please enter the name of responsible person.

Role*

Please enter role.

Address*

Please enter address.

هاتف*

أدخل رقمًا صالحًا

بريد إلكتروني

أدخل عنوان بريد إلكتروني صالح

رسالتك*

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