progeo JOKER EVOLUTION, User Manual

Page: 45 / 48

JOKER EVOLUTION 45
Information form
Send this form to:
RehaTEAM
® s.r.l.
vicolo Negrelli, 4
31040 Castagnole di Paese (TV) Italy
Surname
First name
Date of birth
Place of birth
Address
Town
Province
Post code
Nationality
Phone
Fax
e-mail
Wheelchair model
Serial number
Purchased from
Date of purchase
S ignature
In compliance with Italian law 675/96 on the data protection act, we inform you that your personal
details will be collected and used by us with the exclusive aim of sending out advertising and news
on products offered by our company. Such information will be held on an electronic archive and every
effort will be made to ensure security and privacy. In compliance with article 13 of Italian law
675/96, at any moment you have the right to access, modify, delete or simply oppose the use of
such information held by sending an email to the following address:
progeo@rehateamprogeo.com
Notes