01 Oct - 27 Oct ()

PLEASE FILL OUT ALL REQUIRED FIELDS

Fields marked with * are required,
or fill out a PDF instead and send it as an attachment to sales@inmed.com.ph

Customer Name *

Address *

Contact Person *

Position *

Department *

Telephone / Locals *

Fax no. *

Email Address *

Brand of Product *

Lot number *

Type / Kind of Product *

Product Code *

Number of Pieces Involved *

Size(s) *

Nature of Defect: (Please describe in a clear and concise manner) *