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?
Preview

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

Please provide your email address if you would like to receive an acknowledgement and a copy of your request.

Address

Enter the first 3 digits of your address and then choose your address from the drop-down menu. The following boxes for the city and postal code will be filled in automatically.

Apartment number

Choose from the drop-down menu

City

Postal code

Your availabilities?

Are you sure you want to cancel this request?

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