ProRate PLUS Service Request

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Tell us a bit about you

Salutation

Mr
Ms.

First Name

Last Name *

Job Title

Email Address *

Country Code & Phone Number *

Fax Number

Preferred Language *

Company Name *

Where are you located?

Address *

Address Line2

City *

State / Province

Country *

Zip / Postal Code

PO Number

Service Location

Project Number

Billing Address

Reason for Service Call

Do you have an existing ProRate PLUS Service Package?

Yes
No

Other

Equipment and Controls to be Serviced

Problem

Expected Visit Date

Alternate Visit Date

The personal data that you are providing to us as part of this contact request will be used solely for answering your inquiry or approach and for the associated technical administration. It will not be passed on to third parties. On sending your data, you automatically agree to them being passed on to the USA and other countries.

I agree that details entered in the contact form will be collected and processed to answer my request. <br>Note: You can revoke your consent at any time in the future by sending an e-mail to info@coperion.com.<br> Detailed information on the handling of user data can be found in our <b><a href="/en/support/data-protection/" target="_blank">data protection policy</a></b>. *

ProRate PLUS Service Request

Tell us a bit about you

Where are you located?

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