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Inquiry-form hotspring®

Personal data
1. Personal data
2. Title:*
3. First Name:*
4. Name:*
5. Company:
6. VAT-No:
Personal data 2
2. Position:
3. Street:
4. ZIP / City:
6. Country:
Personal data 3
2. Phone:
3. Fax:
4. Customer no.:
5. E-Mail:*
Commercial data
1. Commercial data
2. Article name:
3. Article number:
4. Quantities
5. Quantity:
6. Quantity unit:
7. Application:
Technical characteristics / Connection / Line connection
1. Technical characteristics
2. Cross section:
3. Length heated:
4. Length unheated:
5. Wattage:
6. Voltage (V):
7. Thermocouple:
8. Coil:
9. Connection
10. Connection head:
11. Type:
12. Line connection
13. Connect. line:
14. Conn. length:
15. Mount:
16. Protective conductor:
Protective coat and grouting material / Mount parts / Position text
1. Protective coat and grouting material
2. Coat:
3. Length (mm):
4. Mount parts
5. Connection head for hotspring®/Maxi
6. Mount part:
7. Position text