COMPLAINT FORM
(Form for submitting a complaint – reporting a defect)

Online store: www.titzmach.com
Communication address:
Mária Lazarová
Žitavská 175/17
951 97 Žitavany
Slovak Republic

Customer:
Full name: .........................................................
Address: .......................................................................
Phone number / email address: ....................................

Product / Service under complaint:
Product name: .................................................................
Proof of purchase / warranty document number: ..............................
Date of purchase: ..........................................................
Delivered accessories: ....................................................

Description of defect:
..............................................................................
..............................................................................
..............................................................................

I propose that my complaint be resolved in the following way (tick as appropriate):
☐ Product replacement
☐ Refund

If the complaint is to be resolved by refund, please provide your bank account number:
IBAN: ...............................................................

In ................................................., on ........................

............................................
Customer signature