Demand of assistance form – Atlantis A02-F5P User Manual
Page 8

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. 
Defect:________________________________________
______________________________________________ 
Type:_____________ Serial Number _______________ 
For more information call:________________________ 
Phone.:_________Fax:__________E-mail:___________ 
Address for sending and retiring of the defective product: 
Surname:______________________________________ 
Name_________________________________________ 
Corporate name (obligatory for the societies)__________ 
ZipCode
 City__________________Contry
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___________________ 
RMA (given by ATLANTIS LAND®):_______________
Consent for the treatment of personal informations.
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 196/03 art.7, to change or to cancell 
them or to oppose their use informing of that ATLANTIS 
LAND
®
, via De Gasperi, 122 – 20017 – Mazzo di Rho
(MI). 
Data________________Signature__________________ 
