Industrial automation | Repair and claim form

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Our address:
KEBA Industrial Automation Germany GmbH
Repair Center
Gewerbestraße 5-9
35633 Lahnau, Germany

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General

Company * Company is a required field

VAT Nr. * VAT Nr. is a required field

Contact *

Mrs. Ms. Mr. Prefer not to say

Firstname * Firstname is a required field

Lastname * Lastname is a required field

Phone

Email *

Email is a required field Please enter an email address

Delivery address

Street * Street is a required field

ZIP * ZIP is a required field

City * City is a required field

Billing address

Use shipping address as billing address

Street * Street is a required field

ZIP * ZIP is a required field

City * City is a required field

Product informations

Product Name * Product Name is a required field

Software version

Serial number *

Serial number is a required field

Specialist contact person

First name * First name is a required field

Last name * Last name is a required field

Problem description

Type of error *

Permanent

Infrequent

User error

Application *

Application is a required field

Conditions of environment *

Conditions of environment is a required field

Please describe the error as detailed as possible, "broken" is not sufficient.*

Error description * Error description is a required field

Error tracing

Is the error traceable?

Yes No

Own repair measures

Did you repair something on your own?

Yes No

Which steps were taken to fix the error?

Description

Repair time

Desired repair time *

Standard: 3 weeks

Express: has to be discussed via phone or email

Privacy

I have read and accept the privacy policy. *

General

Contact

Delivery address

Billing address

Use shipping address as billing address

Billing_address {{ form.bill_address.street }}, {{ form.bill_address.zip }} {{ form.bill_address.city }}

Product informations

Product Name

Software version

Serial number

Specialist

Problem description

Type of error

Application

Conditions of environment

Error description

Error tracing

Yes No

Own repair measures

Yes No {{ form.own_repair_measure_steps }}

Repair time

Standard: 3 weeks Express: has to be discussed via phone or email

Request for repair, complaint, conversion or upgrade

Locations

KEBA AG Headquarters

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