Repairs

Customer Information (fill out all with *signed fields)

Title

First name*

Surname*

Company*

Street and number

Zip code

City

Phone

Fax

Email*

MLFB-No.: (acc. to type label)*

Type of device:

Serial number: (acc. to type label)*

Delivery note number:

responsible person and phone number at Siemens:

Cause of complaint (mark please) *

Job execution (e.g. order acceptance, date of delivery, delivery confirmation

logistics (e.g. false supply, under-delivery, transport damage)

product quality (e.g. missing divides, wrong configuration, function problems)

other:

Other

Reason of complaint (please describe briefly) *

Reason of complaint (please describe briefly) **

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