Customer's details
Company :		Name :
Address :		City :
Service :		Floor :
Telphone :		Fax :
		E-mail :

Equipment details
	Type / Brand / Model	Quotation
		Yes	No
		Above :

Fault details
Other

Modalities
You haven't got an account with ELECTRA, payment according to quotation, prior to repair
You own an account with ELECTRA
Can this form be used as a purchase order ?	Oui	Non
If no, give your order number :
This order must be handed to the technician when you have your equipment serviced.