Customer Complaint Form
Mandatory fields are marked with (*)
Name* :
Address* :
City* :
State* :
Select Any one
ANDAMAN & NICOBAR
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHHATTISGARH
DADRA & NAGAR HAVELI
DAMAN & DIU
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU & KASHMIR
JHARKHAND
KARNATAKA
KERALA
LADAKH
LAKSHADWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ODISHA
PUDUCHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
Contact Person* :
Contact Number* :
Email Id :
Product / Service* :
Select Any
Note Counting Machine
Note Bundling Machine
Currency Authenticating
Currency Detector
Shrink Wrapping Machine
Coin Vending Machine
Digital Media Player/Screen
Sorting Machine
Scanner
Air Purifier
Digital Signage
Others
Machine Make :
Serial Number :
Natue Of Complaint* :
Select Any
Counting Error
No Power
No Display
Coin not dispensing
General Service required
Machine Not Working
Other -please specify
Complaint Details* :
Service Branch :
Select Any one
Enter Image Text* :
Submit