Rolmax - Online service request

Online service request

Client info:

Name and Surname

E-mail Address

Phone number

Street name, house / flat number

City

Post code

Tax ID

Machine stationing address

Reason for the report:

Inspection

Repair / Breakdown

Work to be performed

I consent to the processing of my personal data by PHU Rolmax Gabriel Kurzyna in order to contact me.

3 + 5 = ?