To be completed by buyer! (Please use block letters)
●
A remplir par l’acheteur! (en lettres d’imprimerie, s’il vous plaît) ● Wypełnia
nabywca (drukowanymi literami)
Place of purchase
● Source d’achat ● Miejsce zakupu:
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Sales receipt No.
● Récépissé n° ● Nr paragonu:
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Sales receipt date
● Date du récépissé ● Data paragonu:
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Delivery date
● Date de livraison ● Data dostawy:
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Buyer’s address
● Adresse du client ● Adres nabywcy:
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Telephone
● Téléphone ● Telefon:
...
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Forwarder:
□
Pick-up
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Others
● Par:
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Transporteur
□
Propres
moyens
● Przekazywanie:
□
odbiór w sklepie
□
Inne
Description of complaint
● Déscription de la réclamation ● Prosimy zachować części będące przedmiotem reklamacji do czasu jej
rozpatrzenia.
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Содержание FR44-4153-2
Страница 4: ...510 554 390 434 19 1m...
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