Client identification data:
Name of company: *
Contract No.:
Reported by: *
Tel./Fax: *
Email:
Failure type (HW,SW, electronic security system, electronic fire alarm system, other):
Possible time of remedy:
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Product identification data:
Name or type: *
Manufacturing or licence number:
Product supplied on (date):
Version:
The product is under warranty (yes – no):
Product location address: *
Priority:
Failure description:
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obligatory data*
Indicate the visualisation code: *
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