CUSTOMER SERVICE CENTER
DECLARATION FOR THE ASSUMPTION OF COSTS
Please print the following assumption of costs declaration, then complete and sign this legally binding form
and fax it to ++497720-3909-43 or send by email to [email protected].
Company name:
______________________________________________________________________
Address:
______________________________________________________________________

______________________________________________________________________
______________________________________________________________________
Customer number:
___________________
Customer contact person:
________________________________________________________
Short description of the problem: ______________________________________________________
______________________________________________________
______________________________________________________
Recall required on: _______ Time: from _______ to _______
We herewith declare to cover the costs for the expert customer advice. The accounting is balanced for every
started quarter of an hour. The hourly rate is based on the current pricelist IDECard 2.1:
021131 Hotline-Support, rate for 15 minutes 25 €
021131F Support Remote Maintenance, Connection per FastViewer (remote control), rate for 15 minutes 30 €
021025 Other technical service, per hour 125 €
Order confirmation and invoicing will be issued after completed service.
I / We herewith agree to take over the costs.
place, date:
signature:
Name in block letters:
Order number (will be filled out from IDENTA):
creation date:
IDENTA AUSWEISSYSTEME GMBH
KUNDENSERVICE CENTER
Steinkirchring 16
D-78056 Villingen-Schwenningen
Telefon: ++49 7720-3909-28
Telefax: ++49 7720-3909-43
www.identa.com
13-04-15