To be able to answer you correctly we still need the following informations :
Please fill in the fields marked with an asterisk.

(*)Company Name

(*)VAT number

(*)Madam, Sir ?

(*)Your first Name

(*) Your Name

(*) YOUR ADRESS

(*)STREET NUMBER

(*) Postal code

(*)City

(*)COUNTRY

(*)Your Email Adress

(*) Your mobile phone number

Below, please indicate the desired dates and times for delivery and collection of the equipment, as well as the number of days you will use the equipment.
If you don't yet know the dates, simply enter "not yet known" in the date and time fields.

(*) Desired date and time for delivery of the equipment

(*) DAY(s) USE

(*)Desired date and time for the collection of the equipment

(*) Your Specific Request

COMPLETE DELIVERY ADDRESS

(*)NAME OF THE ROOM WHERE THE EQUIPMENT IS TO BE DELIVERED

(*)HALL PHONE NUMBERHALL PHONE NUMBER

(*)FULL STREET

(*)STREET NUMBER

(*)ZIP CODE

(*)CITY

(*)COUNTRY

RESPONSIBLE FOR THE DELIVERY LOCATION

(*)NAME OF DELIVERY LOCATION CONTACT

(*)MOBILE NUMBER OF DELIVERY LOCATION CONTACT

NAME OF CONTACT ON SITE DURING DELIVERY

(*)NAME OF CONTACT ON SITE FOR RECOVERY

(*)MOBILE NUMBER OF CONTACT ON SITE FOR RECOVERY

(*)NAME OF CONTACT ON SITE FOR RECOVERY

(*)MOBILE NUMBER OF CONTACT ON SITE FOR RECOVERY

MISCELLANEOUS REMARKS

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