1. Consumer Information

Full Name

Document Type
DNIForeigner IDPassportOther

Document Number

Phone Number

Email Address

Address

2. Service Information

Service Description

Amount Paid (if applicable)

3. Claim / Complaint Details

Type
Claim (request for refund or compensation)Complaint (service dissatisfaction)

Issue Description

Consumer Request

5. Acknowledgment

By submitting this form, I declare that the information provided is true and accurate.
[acceptance* acceptance-agreement] I agree and accept.