Coustomer information
Full name:     *Please Insert your full name
Phone:     *8 Digits
E-mail:     *Example@domain.com
Nationality:
Country:
Area:
   *Your Area Kuwait
Street:
Avenue:
Block:
Civil ID:      *12 Digits
Car information
Car Model:
   
Year:
 
Plate Number:
Feedback Reasons
Garage:
  *Select BRANCH location
Reason1:
  *Feedback Reason
Source1:
  *Feedback Reason
Reason2:
Source2:
 
Reason3:
Source3:
 
More information
 
security number       
T Service