Mix'n'Shake Request for Information

Serial number

Article number

Article name

Date of complaint

PPG Representative Name

PPG Representative Email

PPG Representative Phone

Complaint description

Company name

Contact street + nr

Contact postal code

Contact city

Contact Country

Customer contact person

Contact phone

Contact email

Use above information for pick-up?

YesNo

Pick-up company name

Pick-up street + nr

Pick-up postal code

Pick-up city

Pick-up Country

Pick-up contactperson

Pick-up phone

Pick-up email

Please provide us with a vizualization of your complaint and/or documents of your purchase

Enclosure

Enclosure 2

Enclosure 3

Enclosure 4