Complaint Form

COMPLAINT FORM

SELLER

Curliculum s. r. o., Budovcova 188/1, 130 00 Prague, Czech Republic

BUYER

Full Name:
Address (Street, House Number, City, Postal Code): Phone Number:
Email Address:

CLAIMED GOODS / SERVICE

Order Number:
Product Name:
Date of Purchase:
Description of Defect / Malfunction:

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

I request that my complaint be resolved in the following way:

□ Exchange for a new item

□ Refund

□ Other

_____________________________________________________________________________

Date: Customer Signature:

______________________ ______________________

Seller’s Statement (to be completed by the seller)

The complaint was resolved in the following way: Complaint received on: Complaint resolved on:
Handled by: Complaint number: Seller signature: