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Device Details
Product Name: MAXXUS 4.2 R
Serial Number: _______________________________________
Date of Purchase: _____________________________________
Accessories: _________________________________________
Type of Use:
Private Use
Personal Details
Company: ___________________________________________
First Name: __________________________________________
Street: ______________________________________________
Post Code / Town/City: _________________________________
E-Mail: _____________________________________________
Fax. No.*: ___________________________________________
* The fields marked with an asterisk are optional. The remaining fields are mandatory fields that must be completed.
Fault Description
Please enter a short description of the error as precisely as possible below:
(For example, when, where and how does the error occur? Frequency, after which period, at what Use, etc ....)
A copy of the proof of purchase / invoice / receipt is attached.
I accept the General Terms and Conditions of MAXXUS® Group GmbH & Co. KG.
I hereby instruct the company MAXXUS® Group GmbH & Co. KG to repair the above defects. In Warranty cases I will not be charged
for the cost. The costs for repairs which are excluded from liability for defects in quality will be charged to me and must be settled
immediately. In cases of repairs carried out on site, our staff are entitled to collect payment. This agreement is confirmed with here with
my signature.
Date
Please be aware that contracts can only be processed if this form has been completed in full. Be sure to attach a copy of your purchase
invoice. Send the fully completed Repairs Contract / Notification of Damage Claim to:
Post*: Maxxus Group GmbH & Co KG, Service Department, Zeppelinstr. 2, 64331 Weiterstadt
Fax: +49 (0) 6151 39735 400
E-Mail**: customerservice@maxxus.de
* Please stamp with sufficient postage – letters which are not sent postage paid will unfortunately not be accepted.
** Submission by E-Mail is only possible as a scanned document with original signature.
Repairs Contract / Notification of a Damage Claim
Repair order / damage report
Product Group: Recumbent
Invoice Number: ______________________________________
Where Purchased: ____________________________________
________________________________________________
Commercial Use
Contact Person: _______________________________________
Second Name: ________________________________________
House Number: _______________________________________
Country: _____________________________________________
Tel.No.: _____________________________________________
Mobile No.*: __________________________________________
Location
29
ENG
Signature
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