Request for repair

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*Name, Surname:
Identity number:
*Physical address:
*E-mail:
*Phone:
Fax:
*	I am acquainted with privacy policy conditions
*	I confirm use of personal data

*Organization name:
*Register number:
*VAT No.:
*Registered address:
*Physical address:
*Bank name:
*Account No.:
*E-mail:
*Phone:
Fax:
*Contact person:
*	I am acquainted with privacy policy conditions
*	I confirm use of personal data