_______________________________________________________________________________________________________________________ | |
Sucursală/Reprezentanță | |
__________________________________________________________ | |
Seria de șasiu a autovehiculului | |
__________________________________________________________ | |
Număr de operare: | |
__________________________________________________________ | |
Data: | |
_______________________________________________________________________________________________________________________ | |
Cod decontare: | ____________________________________________________________ |
Persoană de contact: | ____________________________________________________________ |
Număr de telefon: | ____________________________________________________________ |
Fax: | ____________________________________________________________ |
Prin E-Mail către: | |