Customer Name \ Surname  * Mr  Mrs  Ms 

Phone Number  *

E-mail  *

Address Contact

City / Country  * Africa  Middle East  Egypt 

Job Professionalism

Complain Category  * Color  Fragrance  Gramage 

Customer Type  * End user  Current Customer  Future Customer  Distributor 

Brand  * Duru  Fax  Activex  Arko  Evy Baby  Evy Lady  Aromel  Sanino  AVA 

SKU Barcode  *

Type of Feedback  *  Complain   Satisfaction   New suggestion  

Message / Comments

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