To be completed by buyer! (Please use block letters)
●
In te vullen door de verkoper! (Graag in drukletters)
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Vom Käufer auszufüllen!
(Bitte in Druckschrift)
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A remplir par l’acheteur! (en lettres d’imprimerie, s’il vous plaît)
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Da compilare dall’acquirente! (in stampatello)
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¡Completa el cliente! (en mayúsculas)
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Fylles ut av kjøper! (Vær vennlig å bruke blokkbokstaver)
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Udfyldes af køber! (Benyt venligst
Blokbogstaver):
Place of purchase
●
Plaats van aankoop
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Bezugsquelle
●
Source d’achat
●
Acquistato presso
●
Lugar de compra
●
Salgssted
●
Salgs sted:
……………………………………………………………
……………………………………………………………
Sales receipt No.
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Aankoopbewijs Nr.
●
Kaufbeleg-Nr.
●
Récépissé n°
●
Prova d’acquisto
N.
●
Recibo N
o
●
Kvitteringsnr
●
Kasse Bon nr
.……..........................................................................
Delivery date
●
Leveringsdatum
●
Lieferdatum
●
Date de livraison
●
Data di consegna
●
Fecha de
Endrega
●
Leveringsdato
●
Leverings dato:
.………………………………………………………….
Buyer’s address
●
Adres koper
●
Kundenanschrift
●
Adresse du client
●
Indirizzo
del cliente
●
Dirección del kliente
●
Kjøpers adresse
●
Købers adresse :
.…………………………………………………………………………………………………
………………………………………………………………………………………………….
Telephone
●
Telefoon
●
Telefon
●
Téléphone
●
Teléfono
●
Telefon
●
Telefon nr:
...……………………..……............................................................................................
Sales receipt date
●
Aankoopbewijs -Datum
●
Kaufbeleg-Datum
●
Date du
récépissé
●
Data prova d’acquisto
●
Fecha recibo
●
Kvitteringsdato
●
Kasse bons
dato:…….…...……………………………………………………………………………….
Forwarder:
□
□
□
□
Pick-up
□
□
□
□
Others
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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
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:
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!
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Содержание ELG18-4533
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