Segnalazione disservizio

Segnalante

Nome e cognome(Obbligatorio)

Nome Cognome

Telefono(Obbligatorio)

Email(Obbligatorio)

Dati segnalazione

Tipo di disservizio(Obbligatorio)

Oggetto della segnalazione(Obbligatorio)

Titolo riassuntivo

Descrizione

Dettagli del disservizio riscontrato

Luogo

Indirizzo e posizione del problema riscontrato

Via/Piazza e numero civico Dettagli posizione Località

Allegati e Foto

Immagini

Eventuali fotografie a documentazione del problema

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Documenti

Altri allegati

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