Duplicate approval LPG tank

FORM

TANK DATA

*TANK NUMBER:
	Field format: NR________
*DIAMETER/CAPACITY:
	Field format: D_____/_____L
*PROD. DATE/EXPIRY DATE:
	Field format: __.__/__.__

INVOICE DATA

* NAME / COMPANY NAME:
*ADDRESS:
*NIP:
*TEL:

SHIPPING INFORMATION (if different from invoice data)

NAME / COMPANY NAME:

ADDRESS:

I consent to the processing of my personal data by POLGAZ AUTO GAZ SYSTEM. I certify that I have been informed that, in accordance with Art. Paragraph 24. 1 Section 4 of the Act on Personal Data Protection provide my data is voluntary and that I have the right to inspect them, as well as the opportunity to correct them.