_______________________________________________________________________________________________________________________ | |
Filiale/rappresentanza | |
__________________________________________________________ | |
Numero d'identificazione del veicolo | |
__________________________________________________________ | |
Numero officina: | |
__________________________________________________________ | |
Data: | |
_______________________________________________________________________________________________________________________ | |
Numero danno: | ____________________________________________________________ |
Persona di contatto: | ____________________________________________________________ |
Numero di telefono: | ____________________________________________________________ |
Fax: | ____________________________________________________________ |
Per e-mail a: | |