Request for service and repair

Current Who are you?
Where is the problem?
The problem you are reporting relates to which category?
What is the problem?
The problem you are reporting is located in which room?
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Who are you?

(Fields marked with an asterisk* are required)

Title

First name

Last name

Phone number

This number is a cell phone number

Second phone or cell number

Email

Address

Apartment number

City

Postal code

Your availabilities?

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