Machine Pickup Form

Fill in this form to have your Würth machine picked up.

*required fields

Contact details

Applicant: *

Company name: *

Customer number: *

Phone number: *

Email address: *

Address details

Pickup address

Name of shop/customer pickup address: *

Street + number: *

Postal code + city: *

Delivery address

Name of shop/customer at pickup address: *

Street + number: *

Postal code + city: *

Article details

Machine type: *

Machine serial number (ORSY fleet customers):

Article number (without spaces):

Accessoires included:

Charger (please always include)

Battery (please always include)

Case

Diamond blade

Grinding disc

Saw blade

Drill bit

Chisel

Bits

Number of batteries included (if supplied):

Description of the defect: *

Additional information for pickup:

Account manager number (employees only):

Warranty claim subject to reservation: *

Yes

Invoice date

Invoice number

Faster repair

Repair approval up to (Enter your amount here)

Repairs under 30% of the sales price, with a maximum of €120, are carried out without a quotation.

For a faster repair, you can increase the amount up to which we may repair your machine without preparing a quotation (>30% of the average sales value). You undertake to respond to the quotation within 14 days. Without a response, the machine will be returned and €49 quotation costs will be charged.

Would you like a replacement machine?

Replacement machine *

Yes

Delivery address

Street + number:

Postal code + city:

After your machine has been repaired, you must return the replacement machine within 14 days. This can be done in one of our shops or via the return form. Würth Belux NV reserves the right to invoice the replacement machine after the 14-day period has expired.