Full name*

Company name*

Address*

Phone number*

E-mail address*

Date and place of incident*

Detailed description of the complaint*

Causes of the problem*

Date*

Signature

I confirm that the personal data provided above belongs to me and I declare my consent for it to be collected, recorded, and stored by MEGA TRANS LOGISTIC for the purpose of communicating a response to the inquiry submitted via this channel.