Claim form

Object*

If "other", please be specific

Yes

Carrier*

Order number (ABxxxxxxxx) Invoice (RGxxxxxxxx) oder Delivery (LSxxxxxxxx)*

Product number*

Product description*

Batch number*

Claim description

Date when problem was observed*

Number of products affected*

Customer number

Title*

First name*

Last name*

Company*

Address*

ZIP*

City*

Country*

Phone*

E-mail address*

Fields marked with asterisks (*) are required.

Privacy *

By selecting continue you confirm that you have read our data protection information and accepted our general terms and conditions.