1. Appliance
2. Client Details
3. Proof of Purchase
Please enter model number (if possible)
Please fill in a detailed fault description of the appliance*
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Name
Surname
Tel (Home)
Tel (Work)
Cell*
Email*
Street Name and Nr*
Suburb*
Town/City*
Province* Western CapeEastern CapeNorthern CapeKwaZulu NatalGautengMpumalangaLimpopoNorth WestFree State
FirstPrevious
Purchase Date*
Invoice Number*
Store Name
Store Branch
Proof of Purchase
