Guarantee application Company * Name * Phone * Email * Type of vehicle * Serial number * Start-up date * Operating hours * Date of repair * Assembly number * Type of engine/number * Date of loss or damage * Description of loss or damage Attach image Repair details Cost report Assembly hours Journey time Driven km Other costs Third-party costs Material consumption Material used Art.-No. of the material Part name Value in € Delivered on Sum of the cost report Total I confirm that all the information included in this form is true. * I hereby agree to my data being stored and used by Bergmann for the purpose of handling my request. I know that I can revoke my consent at any time by sending an e-mail to service@bergmann-mb.de. For further information on the handling of data please see our Privacy Policy. * *mandatory field Send