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Application Date: 14-11-2018
Company Name:
NIP:
Type of the product:
Serial Number:
Invoice number:
Length of installation [lm]:
Diameter liquid:
Diameter gas:
Amount of bends 90:
Refrigerant addition [kg]:
Total refrigerant charge [kg]:
Height difference:
Circuit breaker [A]:
Running current [A]:
Power supply [V]:
Temperature:
Malfunction description
Error code:

Components

Catalog Number Part name Quantity Price USD Value USD  

Customer detailes

Name:
Surname:
Phone Number:
E-mail:
Transport Type:
Company Name:
Street:
ZIP Code:
CIty:
Contact Person:
Phone Number:
Attachment (copy of the warranty book):
I understand and accept mentioned above conditions:
First and lastname the person completing the form
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