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SERVICE REQUEST CARD

Date:
Company name:
First and last name:
Phone number (required):
E-mail (required):
Location of equipment   (building):
Equipment type:
Working hours counter:
Serial number of equipment:
Request (required):
WARRANTY (FREE OF CHARGE) 
ORDERED REPAIR (PAID)
PERIODIC INSPECTION (PAID)
OTHER
Description of the request (required):
File:
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