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Service outlet/Operation no. | Customer | |
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Vehicle ident. no. | Repair job no. | |
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Tester: Name | Date | |
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License plate number Initial registration Model | Engine no. | Odometer reading: km/miles |
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Accounting number: | 5891249 |
Contact: | ____________________________________________________________ |
Telephone number: | ____________________________________________________________ |
Fax: | ____________________________________________________________ |
Send by email to: | |