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Retailer:
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Invoice:
PROBLEM DESCRIPTION:
Problem type
Defect
Broken
Non-Performance
Missing Part
Other
Product code
Product name
FOR (INFOS FINAL CLIENT):
Last name:
*
First name:
*
Address:
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City:
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Country:
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Prov.:
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Manitoba
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Newfoundland and Labrador
Northwest Territories
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P.C.:
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Tel.:
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