
"
Acknowledgement of receipt
No right to claim warranty if this acknowledgement of receipt has not been returned!
* Mandatory eld
To
Dealer
Cust. No.: .................................................
Company ..................................................*
Street: ......................................................*
ZIP-Code: ................................................*
Place: .......................................................*
Country: ...................................................*
Phone: .....................................................
Fax: ..........................................................
E-Mail: ......................................................
New machine sold to nal customer - Initial use*
Customer's machine - Relocation*
Demonstration machine - Initial use*
Demonstration machine - Relocation*
Demonstration machine sold to nal cus-
tomer - Use*
Machine type: ..........................................*
Serial number: ..........................................*
Service engineer
Name: ......................................................*
First name: ...............................................*
I hereby conrm the receipt of the operating instructions and spare parts list for the machine
specied above.
I have been instructed by an authorized dealer or a Service Engineer from HORSCH in the oper-
ation and functions as well as the safety related requirements of the machine.
I am aware, that the right to claim warranty will only be eective, if this form is returned to the
responsible dealer or handed over to the Service Engineer, properly completed immediately after
initial instruction.
........................................................................*
Signature of buyer
........................................................................*
Place, date of initial instruction
Customer I:
Name/company: ......................................*
Name of contact: .....................................*
First name of contact: ..............................*
Road: .......................................................*
ZIP-Code: ................................................*
Place: .......................................................*
Country: ...................................................*
Phone ......................................................*
Fax: ..........................................................
E-Mail: ......................................................*
Customer II:
Name/company: ......................................*
Name of contact: .....................................*
First name of contact: ..............................*
Road: .......................................................*
ZIP-Code: ................................................*
Place: .......................................................*
Country: ...................................................*
Phone ......................................................*
Fax: ..........................................................
E-Mail: ......................................................*