1. Customer data
Company Name
Contact person (Optional)
Street and house number
Postal Code
City
Phone
E-mail address
2. Car data
Brand
Model
License Plate
Chassis number
Part(s) to be repaired (Multiple options possible)
Seatbelt tensioner
Replacing seatbeltRepair blockingRepair SpringtensionRepair after accident
Airbagmodule
Reset after accidentRepair after spontaneous failure
Present error codes
Clockspring
Other
Other:
3. Other information
With which delivery service will the package be sent? PostNLOther
PostNL
Do you ship with PostNL? Then send your package to: Het Riet 15, 5431 NL in Cuijk
Do you ship with another delivery service? Then send your package to our visiting address: Het Riet 15, 5431 NL in Cuijk
What is the capital of the Netherlands? (spam prevention)
+31 (0)485-331199
