Duplicate

I N F O R M A T I O N

In case of losing the certificate of the tank please fulfill below application.

A P P L I C A T I O N

I would like you to issue me the duplicate of tank certificate.

Please fill the application carefully!

__.FORM action='strona.php3' method='post'.____.INPUT type='hidden' value='cms_gzwme_en' name='cms'.____.INPUT type='hidden' value='7' name='id_dok'.____.INPUT type='hidden' value='6' name='id_men'.____.INPUT type='hidden' value='a' name='lad'.____.INPUT type='hidden' value='999' name='wyk'.____.INPUT type='hidden' value='Your message has been sent successfully.' name='konf_tekst_ok'.____.INPUT type='hidden' value='Sending message failed!' name='konf_tekst_nieok'.____.INPUT type='hidden' value='Wiadomość z formularza na stronie www - wydanie duplikatu - wersja angielska' name='konf_temat'.____.INPUT type='hidden' value='duplikat' name='konf_ado1'.____.INPUT type='hidden' value='gzwm.com.pl' name='konf_ado2'.____.INPUT type='hidden' value='duplikat' name='konf_aod1'.____.INPUT type='hidden' value='gzwm.com.pl' name='konf_aod2'.__

Name:	__.INPUT TYPE='TEXT' NAME='nazwisko_i_imie' SIZE='60' CLASS='wpisz'.__*
Address:	__.INPUT TYPE='TEXT' NAME='firma_adres' SIZE='60' CLASS='wpisz'.__*
Telephone:	__.INPUT TYPE='TEXT' NAME='telefon' SIZE='60' CLASS='wpisz'.__*
E-mail:	__.INPUT TYPE='TEXT' NAME='email' SIZE='60' CLASS='wpisz'.__*
Homologation number:	__.INPUT TYPE='TEXT' NAME='numer_homologacji' SIZE='60' CLASS='wpisz'.__*
Tank capacity:	__.INPUT TYPE='TEXT' NAME='pojemnosc_zbiornika' SIZE='60' CLASS='wpisz'.__*
Tank number:	__.INPUT TYPE='TEXT' NAME='numer_zbiornika' SIZE='60' CLASS='wpisz'.__*
Date of production:	__.INPUT TYPE='TEXT' NAME='data_produkcji' SIZE='60' CLASS='wpisz'.__*
	__.INPUT type='submit' value='Send the application' name='konf_wyslij' CLASS='klawisz'.__*

__./FORM.__

*) - required fields

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