757. AppendixTO: NEC or NEC's Authorized Service Station:FM:(Company & Name with signature)Dear Sir (s),I would like to apply your TravelCare Service Program based on attached registration and qualification sheet and agree with yourfollowing conditions, and also the Service fee will be charged to my credit card account, if I don't return the Loan units within thespecified period. I also confirm following information is correct. Regards.Application Sheet for TravelCare Service ProgramP-1/ ,Country,product purchased :User's Company Name :User's Company Address :Phone No., Fax No. :User's Name :User's Address :Phone No., Fax No. :Local Contact office :Local Contact office Address :Phone No., Fax No. :User's Model Name :Date of Purchase :Serial No. on cabinet :Problem of units per User :Required Service : (1) Repair and Return (2) Loan unitRequested period of Loan unit :Payment method : (1) Credit Card (2) Travelers Cheque (3) CashIn Case of Credit Card :Card No. w/Valid Date :Date: / / ,
