Verkbeiðni

Nafn fyrirtækis / Company name *
Kennitala fyrirtækis / Company identification number *
Heimilisfang - Verkstaður / Address - Place of work (a place where there is a broken device) *
Nafn tengiliðs / Contact name *
Sími / Phone number *
Netfang / Email address *
Viðfangsefni - Nafn á tæki / Subject - Device name *
Greinagóð bilunarlýsing / Clear fault description *
Viðhengi / Attachment :
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