Automated Test Tool Order Form

Company

Company name*

Address*

Street Address Address Line 2 City ZIP / Postal Code Country

Telephone General*

Contactperson

Name*

First Middle Last

Function*

Telephone Direct*

Email*

Purchase Order

PO number for funding OpenTherm Automated Test Tool of the amount of €3.500,00 (ex. VAT)

VAT number*

Mandatory for countries belonging to the European Union (EU)

EORI number*

Economic Operators Registration and Identification number (EORI number)

Invoicing e-mail address*

Quantity of OpenTherm Automated Test Tool = 1*

The maximum is 1 TestTool per member per year

Consent*

I consent

- The undersigned hereby declares that the invoice with the amount of € 3.500,00 (ex. VAT) apiece will be paid as soon as possible after the invoice is received, but not later than 2 weeks after invoice date.
- Test tools will only be shipped after receipt of payment.
- Test tools will only be shipped to the company address of the Open Therm Association's member, not to subsidiaries.

Name*

First Middle Last

Function*

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