Fritz-Erler Str. 44B ,  52349 Duren
Tel.  02421-9920001  , Fax. 02421-9920002

Repair request form
Customer/Name/Company    
Contact:  
Address:  
Post Code/Town:  
Tel.:  
Fax:  
Email:  
     
Vehicle data    
Make:  
Model:  
Chassis No.:  
Year:  
Mileage (Km):  
Part:  
     
Type of repair/description of fault:
     
I hereby instruct RickimAuto to carry out repair work on the above part.

I accept the General Terms and Conditions
of Rickim Auto Elektronik GmbH.                            


Date:
 

Signature:
     

[ Back to Homepage]