Repairform - My ABC

Please complete the required details.

Company name *

Branch / department

First name *

Surname *

E-mail address *

Telephone / Mobile

Are you already a customer of ABC?

I'm already a customer of ABC.

I'm not yet a customer of ABC.

Billing address

Street + number *

City *

Country *

Extra info

Vat number *

E-invoicing e-mail-address *

Administrative contact person

Send the offer/repair price to this e-mail address.

Send the offer/repair price to another contact person.

Firstname *

E-mail address *

Surname *

Telephone/mobile

Repair details

TIP! Multiple repairs?
At the end of the form you can start a new request without having to fill in your customer info again!

Brand/Type *

Error description *

Choose a priority.

Low with quotation

Quotation within 4 weeks, analysis and draw up of your quotation is free of charge, even if you will not let us preform the repair!

Low without quotation

Medium with quoatation

Quotation within a weeks time, in case of rejection, administrative costs will be charged

High

Immediate implementation, Performing repair is done on a time and expense basis. Should we cease the repair, then no additional costs will be charged!

I accept that an administrative cost will be charged for every declined offer.

Do you want to receive an offer for an exchange or a sparepart together with your repair offer?

Yes

Overview

Contact details

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placeholder naam

placeholder email

placeholder phone

Repair

placeholder merk/type

placeholder foutbeschrijving

Priority

placeholder prioriteit

placeholder sparepart

Extra

Attachment(s)

Attention: All attachments must have a unique name.

Add electrical diagrams.

I have read and agree to the terms and conditions.

Read our terms and conditions.

Repair request

This only takes a few minutes.