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Fields marked with a * are mandatory.
Claimant / Office
Customer number*
Contact person
Company*
Street/number*
post code (zip code)*		town
phone number*
fax number*
email*
Collection/delivery address, if different
Contact person
Company
Street/number
post code (zip code)		town
Delivery note number*
Delivery date*

1. Article number*
Description*
Serial number*
Quantity*
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2. Article number
Description
Serial number
Quantity
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3. Article number
Description
Serial number
Quantity
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4. Article number
Description
Serial number
Quantity
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5. Art. Nr
Description
Serial number
Quantity

You will receive an email from us, please return this email with pictures of the damaged products.

Reason for return: *  Transport damage  Faulty / damaged product  Returned consignment   Form of refund: *  Credit note  replacement delivery

Description of the damage / reasons for return, with transport damage - dispatch number
Please calculate *
Your Score*