To be completed by buyer! (Please use block letters)
●
In te vullen door de verkoper! (Graag in drukletters) ●
Vom Käufer auszufüllen!
(Bitte in Druckschrift) ● A remplir par l’acheteur! (en lettres d’imprimerie, s’il vous plaît) ● Da compilare dall’acquirente! (in stampatello) ●
¡Completa el cliente! (en mayúsculas) ● Fylles ut av kjøper! (Vær vennlig å bruke blokkbokstaver) ● Udfyldes af køber! (Benyt venligst
Blokbogstaver) ● Ostaja täyttää! (Ole hyvä ja käytä isoja kirjaimia) ● Fylls i av köparen! (Vänligen texta):
Place of purchase
● Plaats van aankoop ● Bezugsquelle ●
Source d’achat ● Acquistato presso ● Lugar de compra ●
Salgssted ● Salgs sted ● Ostopaikka ● Inköpsställe:
……………………………………………………………………………
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Sales receipt No.
● Aankoopbewijs Nr. ● Kaufbeleg-Nr. ●
Récépissé n° ● Prova d’acquisto N. ● Recibo N
o
● Kvitteringsnr ●
Kasse Bon nr ● Kassakuitin numero ● Försäljningskvittots
nummer:
.……................................................................................................
Sales receipt date
● Aankoopbewijs -Datum ● Kaufbeleg-Datum
● Date du récépissé ● Data prova d’acquisto ● Fecha recibo ●
Kvitteringsdato ● Kasse bons dato ● Kassakuitin päiväys ●
Försäljningskvittots datum:
…….…...…………………………………………………………………
Delivery date
● Leveringsdatum ● Lieferdatum ● Date de
livraison ● Data di consegna ● Fecha de Endrega ●
Leveringsdato ● Leverings dato ● Toimituspäivä ●
Leveransdatum:
.…………………………………………………………………………..
Buyer’s address
● Adres koper ● Kundenanschrift ● Adresse du
client ● Indirizzo del cliente ● Dirección del kliente ● Kjøpers adresse
● Købers adresse ● Ostajan osoite ● Köparens adress:
.………………………………………………………………………………..
…………………………………………………………………………………
…………………………………………………………………………………
Telephone
● Telefoon ● Telefon ● Téléphone ● Teléfono ● Telefon ●
Telefon nr ● Puhelin ● Telefon:
...……………………..……......................................................................
Forwarder:
□
Pick-up
□
Others
● Door:
□
Verzending
□
Zelf ●
Afhalen:
□
Spedition
□
Selbstabholer ● Par:
□
Transporteur
□
Propres moyens ● Tramite:
□
Spedizioniere
□
Mezzo proprio ●
Entrega:Transporte organizado
□
transporte propio ● Transportør:
□
Sendes
□
Hentes ● Transportør:
□
Sendes
□
Hentes ●
Rahdinkuljettaja:
□
Nouto
□
Muut ● Speditör:
□
Avhämtning
□
Övrigt
Description of complaint
● Beschrijving van de klacht ● Schilderung der Beanstandung ● Déscription de la réclamation ● Descrizione
della reclamazione ● Descripción del problema ● Beskrivelse av feil/ mangel ● Beskrivelse af fejl / Mangel ● Valituksen kuvaus ●
Beskrivning av reklamationen:
Please keep the parts which are the object of the complaint until the complaint is settled!
● Gelieve
de betrokken onderdelen te bewaren tot de klacht is afgehandeld ● Veuillez garder les pièces contestées jusqu’à ce que la réclamation soit
traitée définitivement! ● Si prega di conservare i pezzi reclamati fino all’evasione della reclamazione! ● Por favor, conserve las piezas
objeto de la queja hasta que el problema haya sido resuelto ● Please Vær vennlig å ta vare på de aktuelle delene/ produktet inntil saken er
avsluttet! ● Venligst ta hånd om de aktueller dele / produkt indtil sagen er afsluttet! ● Ole hyvä ja säilytä osat, joita valitus koskee, kunnes
valitus on käsitelty! ● Vänligen behåll delarna som är föremål för reklamation tills reklamationen har behandlats!
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Содержание ELG16-2728
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