Registration form for TECHNICAL SERVICE

Fax. +49-89-85461-168 or Email:

53rd International BICOM Congress 2013

From Friday the 3rd to Sunday the 5th of May 2013

Name: ______Customer number (found on an invoice)

Address:______Postal code______City______Country______

Technical service for your device is only possible if you send this form beforethe BICOM Congress.

If you have more than one device we ask you to register each device separately.

I would like to have the technical service carried out during the BICOM Congress in Fuldafrom the3rd to the 5th of May 2013for the following device:

BICOM optima€146,00Please note: All prices are without

BICOM optima mobil€146,00VAT and valid for the technical

BICOM version 4.1n to BICOM 2000€110,00service mentioned below.

BICOM Mobil€110,00Worn out parts and any spare

MRT€110,00parts needed will be charged

Travel/Vet€110,00extra.

language version of your device: English German  other______

Due to full capacity in the technical department the following devices cannot be checked in Fulda:

BICOM versions 2.3, 3.2, 4.0a, and 4.1u and Multicom. If interested kindly contact your local representative or us directly.

Replace battery  yes  no  if necessary

(The number can be found on the

Device number (obligatory) back side of the device)

The technical service covers the basic checkwhich includes the following:

  1. Inspection of all mechanical and electrical functions of the Bicom device
  2. Check / readjustment of all technical parameters
  3. Safety test and software updates

Unfortunately it is not possible to give a quotation on repairs in Fulda due to lack of time.

Additionally the following check or repair should be carried out:

______

______

Please include only your mains charger as this also needs to undergo a technical safety check!

Date:______Signature______

You can drop off your device starting Thursdaythe 2nd May from 3 pm,at the technical service counter in the Maritim Schlosshotel, Fulda.