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First Name:*

Last Name:*

Email:*

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Description of problem*

Street*

Town or city*

State*

Postcode*

Phone*

Which Torqeedo model is the subject of this claim

Which Torqeedo model:*

For Travel and Cruise models choose shaft length

Shaft length:*

Date of purchase*

Serial number*

Estimated hours of use*

Dealer where purchased*

Dealer address*

Tip: just attach a photograph the proof of purchase if you have only a paper copy

Please attach proof of purchase*

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