Complaint Form

To file your claim, you can fill out the form below...

Identification of the complaining consumer

Are you filing as a company or a person?

PersonCompany

Name *

Last Name *

Phone Number *

Other Phone

Document Type *

Document Number *

Address Type *

Select Address TypeHomeDepartmentCondominiumResidentialOfficeLocalCenterMarketGalleryOther

Address *

No/Lot *

Dept./Int.

Department *

province

District

Email Address *

Are you underage

Identification of the contracted good

Service or Product?

ServiceProduct

Amount Claimed *

Description *

Place, date and time of occurrenceOrder *

Details of the Claim or Complaint

ClaimComplaint

Detail *

Order *

Actions taken by the supplier

Additional Details *

Submit