First Name: *
Last Name: *
Email ID:
Mobile No: *
Company/Firm/Organization:
Subject:
Your message:
Feedback Type: * ComplaintComplimentGeneral Feedback
Date Reported or Discussed: *
Your Name: *
Best Contact Method for us to respond: * —Please choose an option—PhoneEmailIn PersonNo Response necessary
Please provide Details: *
Was this discussed or reported to anyone? If so, who?
Are there any Outcomes you would like to see happen regarding this?
Please attach any further documentation (Acceptable File Type: doc|docx|pdf|jpg|jpeg|png under 2MB)
KhataNo.1133/2063, Plotno.1732/5788, Lane-L6, ITER College Road, Jagamohan Nagar, Bhubaneswar, Khurda, Odisha, 751030
+91 911 439 4118
[email protected]