Raytalk Industries

Applier Data

Company Name
Name	Surname
Address	City
State or Province	Zip Code
Telephone	Fax
Mobile	Skype
Email	Web Site
Customer Id (please see invoice)

Device technical data

Brand	Model
Serial Number	Other Device
Purchased From	MAC Address

Problem Description

Detail the type of installation in order to give us a better perspective:

Detail the problem you encountered:

How would you be answered?

Telephone Email Other

Personal information aknowledge

Agreement in accordance with Italian law no. 196/2003:
your informations submitted in this module, will be stored on protected data processing systems and considered useful for the warranty contract establishment and execution.In accordance with Italian law no. 196/2003 you can modify or delete your personal informations in any moment and completely free of charge, otherwise you can oppose the entire use or part of it for the purposes quoted above, writing to RayTalk Industries s.r.l., via Nicolino di Galasso n.19 , 47899 Galazzano (Republic of San Marino) for the attention of the technical support manager.

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