Customer information:
Name contact person: *    
Email address: *    
Phone number: *    
Company name: *    
Country: *    
City: *    
Address: *    
Zip Code: *    
Customer Type: * distributor
*Name of distributor
Device information
Firmware version: *  

Complete device serial number:

*

Start date: *  
Turn in XML / Excel File: *

Verification: please type the numbers you see in the box to the right

*

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