Sales Force: Support Request BL US

Subject*

Salutation*

Title

Name*

First Last

Practice / Organization*

Address*

Street Address ZIP / Postal Code City State

Email*

Phone

Camera Serial Number

(The camera SN label is located underneath the camera head)

Your request*

With * marked fields are obligatory.

Agreement*

I agree that Heidelberg Engineering GmbH may transfer this data solely for the purpose of responding to my contact inquiry to Heidelberg Engineering Inc.. Heidelberg Engineering Inc. is the fully owned subsidiary of Heidelberg Engineering GmbH in the United States and processes data in compliance with local data protection laws and regulations. I confirm that I have read and accept the privacy policy. I understand that I can object to the use of my personal data with future effect at any time. I can address a revocation directly to the contact data stored in the privacy policy.