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
Location:
  *Select BRANCH location
Reason1:
  *Feedback Reason
Reason2:
Reason3:
More information
 
security number       
Parts