Biodom 27 A - Page 55

WARRANTY CARD NUMBER:
BUYER:
NAME AND SURNAME:
STREET AND HOUSE NO.:
CITY:
PHONE NO/GSM: __________________E-MAIL:
DATE OF SALE:
INVOICE NUMBER:
PRODUCT TYPE:
SERIAL NUMBER:
COMMISSIONING OF THE DEVICE
DATE OF COMMISSIONING:
AUTHORIZED COMPANY NAME:
STREET AND HOUSE NO.:
CITY:
PHONE NO.:
NAME AND SURNAME OF SERVISER:
SERIAL NUMBER:
STAMP AND SIGNATURE OF SERVISER:
(FILLS IN AN AUTHORIZED SERVICE COMPANY)
COMPLETED FORM RETURN TO BIODOM