Demand of assistance Form
Fill all the blanks, attach always a copy of the proof of purchase (Sale Receipt or Invoice),
and add it all to the product for which you are asking for assistance.
RMA (given by ATLANTIS LAND®):_____________________________________________________
Defect: ___________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Type: __________________________Serial Number: _____________________________________
For more information call: ____________________________________________________________
Phone: __________________Fax:
Address for sending and retiring of the defective product:
Surname: _________________________________________________________________________
Name: ___________________________________________________________________________
Corporate name (obligatory for the societies) ____________________________________________
Zip code __________________City ____________________________________________________
Street ______________________________________________________n_____________________
Tax Code or VAT Number __________________ _____________________(you must always write it)
I agree with this with all the clauses of Guarantee, paying particular attention to
the restrictive ones, shown by ATLANTIS LAND® for this product.
Date __________________Signature___________________________________________________
Consent for the treatment of information according to law 675/96 art. 11and 12
PRIVACY TUTELAGE
I authorize ATLANTIS LAND® to insert my personal information into its data bank, with the only aim to apply the Guarantee to the product over mentioned and for the future administrative, commercial and statistic management.
At any time I will be allowed to ask , according to law 675/96 art.13, to change or to cancel them or to oppose their use informing of that ATLANTIS LAND®, via De Gasperi, 122 – 20017 – Mazzo di Rho (MI).
Date __________________Signature______________________________________________________________________________
N.B.: The award of the information is facultative, but its lack will prevent ATLANTIS LAND® from starting the Guarantee process requested.
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