Lorem ipsum dolor sit amet, consectetur adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa.
YesNo
Entry channelOption 1Option 2
Operation channelOption 1Option 2Option 3
Operation / product / serviceProduct 1Product 2
ReasonReason 1Reason 2
Sub reasonSub reason 1Sub reason 2
DepartmentLimaArequipa
ProvinceProvince 1Province 2
DistrictSurcoMirafloresEtc
Response channelOption 1Option 2
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