Service Request - AUTO-FORM

Submission Details

Location of Submission *

Submission Date *

Submitter's Details

Name *

Tax Identification Number (NIP) *

Address *

City/Town *

Postal Code *

Country *

Service Scope

Additional EquipmentRepairInspection of the medical compartment

Vehicle Details

Ambulance Brand *

Model *

Vehicle Identification Number (VIN) *

Contact Person

Name *

Phone Number *

Email Address *

Notes and Attachments to the Submission

Notes

Attachments

Maximum size of a single attachment: 8 MB
Maximum total size of attachments: 64 MB
Maximum number of attachments: 20

Summary

A copy of the form will be sent to the address: {email-1}
After submitting the form, please wait for a confirmation message regarding its submission.

Confirmation of receiving the form is obtaining its copy sent to the provided email address (it might be found in the "spam" section).
In case of any issues, please contact us:
By phone: +48 500 255 529
By email: serwis@autoform.pl

Service Request Form

Polish version / Usługa serwisowa