* compulsory field

Business Name*

Email*

TAX ID / VAT*

Country*
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Delivery note number*

Invoice number*

Date of reception*
Date of reception*

Affected product reference*

Lot number

Product description*

Problem / defect*

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Affected product reference*

Lot number

Product description*

Problem / defect*

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[group group-reference-2]
Affected product reference*

Lot number

Product description*

Problem / defect*

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