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Customer: Supplier:
Address: Date of delivery
form:
Product:
Date of failure:
Serial number:
Descripon of failure:
Qty: Part No: Part name: Price EUR: Sum credit EUR:
Hours of work performed: Hour rate EUR:
Hours of travel: Hour rate EUR:
Mileage: Km at EUR:
Orkel Consultant: Invoice new parts:
Place and date: Signature:
Warranty report received date: Warranty parts returned/pictures received:
Dismissal: Approved:
Ground for dismissal:
The claim is considered:
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