O R D E R - FOR M - Food SafetyBusiness Unit

WESSLING Hungary Kft.

H-1045 Budapest, Anonymus utca 6.

Tel: (+36-1) 872-3600

Fax: (+36-1) 435-0101

Customer passing the Order: / Data of Customer / Address:
Supplier/Forwarder: / Phone/Telefax:
Name of the Sampling Person: / e-mail:
Time of Sampling: / year / month / day / Contact Person:
Place of Sampling: / VAT number:
Ref. Number of the Price Quotation: / Cost Bearer:
(if different from Customer) / Name:
Contract Number: / Address:
Description of the Sample(s)
(to enter on Report) / Sample(s) identifying data
(to enter on Report) / Number of Sample items / Packing size / Packing type / Analyses/Measurements ordered / significant circumstances affecting the order (Remarks)
Opinions *
Date and Time of taking over the Sample(s) / year / month / day / hour / minute / Deadline requested for / Normal / URGENTLY :with 40 % Surcharge
*(500 Ft.) Based on provisions of Law, MÉ,Specifications / Report (pieces)* / Hungarian / English / German / send
We order hereby for the above indicated examinations/measurements / Signature / Report types: (the requested alternative to be underlined) / 1 Copy of Report to each Sample/
1 Single Report covering the entire Order
Receiving Party
(to be filled in by WESSLING) / Signature / *Prices include the costs of one electronically sent Examination Report in English or German or Hungarian language. Further copies can be ordered against 1000 HUF in the same language nor against 2000 HUF in a different one out of the above three languages
To send the report by post - if there is no other agreement - is possible by paying the administration fee.
Compulsory field

I, Customer, am aware of the fact that, in the absence of any other written agreement, the general terms and conditions that can be downloaded from the address apply to the Contract entered into by the Customer and WESSLING Hungary Kft. on the basis of the present order. The Customer acknowledges that all capitalized terms in the present Order that are not proper names possess the meaning defined in the general terms and conditions. By signing the Order, the Customer declares that

a)they are aware of and accept the general terms and conditions of WESSLING Hungary Kft.,

b)all relevant facts, pertaining to the Contract, have been indicated in the Order,

c)all of their prior oral or written statements are vacated, since the Order contains all of their statements, and

d) they do not wish their prior oral or written statements to be taken into consideration when interpreting the Contract.

F-20/E Order Form
Version 5/05December 2017 / Page:
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