Cégnév / Company name:*
Ir.sz., város / ZIP, city:**
Utca, házszám / Street, nr.:*
Megszólítás / Prefix:*
Vezetéknév / Surname:*
Keresztnév / First name:*
Telefonszám / Phone nr.:*
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E-mail cím / E-mail address:
Termék megnevezése / Denomination of device:*
Termék azonosító / Product nr. (7 számjegyű / 7 digit):*
Szériaszám / Serial nr.:*
2. Termék megnevezése / Denomination of device:
2. Termék azonosító / Product nr. (7 számjegyű / 7 digit):
2. Szériaszám / Serial nr.:
Hiba leírása, eszköz hibajelzése / Fault description:*
