Name of the optician
E-mail adress
Shipping address
Phone number
Tax ID No.
Model number
Color (required)Select an optionC01C02C03
Claimed part (required)Select an optionFrontRight templeLeft templeFlexDecorative elementLensWholeOther
Reason for the complaint (required)Select an optionBroken templeChippingUnsolderingCrackLoss of colourScratchCrookedDamaged threadOther
Report typeSelect an optionComplaintPart purchase
Remarks