Requested repair type
Free, according to warranty terms and conditions (during warranty period)
Paid, for example after warranty period or due to damage made by user

Your reference number*:
Request date:

Customer information
Full company name:

Full company address / invoice address
Post code:City: Country:
EU tax (VAT) number: (if country is EU member)

Pick up and delivery address (if different than above)
Full company name
Post code:City:Country:

Contact data
Title (Mrs/Mr):NameSurname
E-mail address:
Phone (with country code):MobileFax

Information about device
Part number as seen on invoice or on device label:
Serial number:
LUMEL invoice number:
Invoice date:
Failure description (symptoms):

Add picture**
Add picture**

Package information
Dimensions (cm) Weight (kg)
LUMEL S.A. orders a courier to pick up (warranty only)
The customer sends at his own expense

* optional
** max 3 pictures, max 15MB size of all files

Important information:

  1. All white fields are MANDATORY. Without mandatory fields this form will be rejected as it cannot be processed.
  2. The photocopy of the invoice (proof of purchase) must be provided with this warranty repair claim.
  3. Request status may be changed after an analysis by LUMEL, the client will be fully informed about the change.
  4. In the case of warranty repairs, please order UPS courier at the expense of LUMEL S.A. Please use customenr no: 1E5Y76
    You can send your device at your own expense to the following address.
  5. In case of paid repairs, send the parcel by any courier, at the expense of the customer to the address below.
    Shipping with the note "SERWIS"
    LUMEL S.A.
    Attn: SERVICE
    ul. Slubicka 4
    65-127 Zielona Gora
  6. Contact with the service from 8.00AM to 4.00PM
    phonoe: +48 68 457 51 50 or +48 733 313 043

  7. Please include the service request for each device separately if you send more than one device.
  8. Devices can be delivered to the service without the additional equipment like terminal strips, holders, software CDs, CF or SD cards.
  9. Please pack the devices with care, because the LUMEL will not be responsible for the damaged shipments.

According to the Act of 29 August 1997 Personal Data Protection (Journal of Laws of 2002. No. 101, item. 926, amended. d. ) I agree to process my personal information by LUMEL SA ul. Słubicka 4 65-127 Zielona Góra, for making process. I declare that I know the rights to access, change and to request to stop processing such information. I am providing this information voluntarily.