Specialized Technical Assistance (ATS) Form - mix

SPECIALIZED TECHNICAL ASSISTANCE
INTERVENTION REQUEST
Applicant:
Telephone:
Company:
E-mail:
Intervention’s address:
Required date for the intervention:
VERSION 07/2015
OBJECT OF THE INTERVENTION:
¨ Environmental Diagnosis on site
¨ Smoke tests with video
¨ Thermographic analysis
¨ Technical intervention off-site
¨ Technical assistante to the assemblying
¨ Technical assistante to the plant’s trial
¨ Other : ________________________________________________________________________________________
1-
Total €
Intervention day
Lump sum for each day, or part of day, of absence from headquarters:
Marco Zambolin
1.200 €/day
n° days
Senior technician
900 €/day
n° days
Generic technician
400 €/day
n° days
2-
______
______
______
Smoke tests with video
Smoke tests with photo and video montages (n°3 smoke pots max)
1.800 €
Amount for each additional smoke pot
100 €
Discount for prior authorization to the disclosure of videos for educational
and commercial use
- 50 %
3-
____________
____________
____________
Thermographic analysis
Lump sum up to 10 thermographic images
Extra amount for each additional picture
4-
____________
____________
____________
600 €
50 €
____________
____________
…… €
…... €/Km
€
____________
____________
____________
Other costs
Lump sum for board and lodging (hotel and restaurant)
Kilometers :…………….
Travel costs:
TOTAL AMOUNT FOR THE INTERVENTION:
Discount reserved to you:
€ ____________
____________
TOTAL AMOUNT FOR THE INTERVENTION:
€ ____________
Supply conditions:
v Payments: To be confirmed
Notes:
Approval signature and stamp:
Da:
SINTRA s.r.l. : Corso Europa,24-28010 - Z.I. Fontaneto d'Agogna (NO) - Tel. +39.0322.863601 - Fax +39.0322.863688 /P.Iva 01624740187 - Capitale soc.118.000 €.
http : //www.mix-ind.it
E-mail : [email protected]
Bureau de liaison France : 31-33, Rue des Clotais – 94
360 Bry sur Marne - Tél. +33.01.55.12.18.96. Fax +33.01.48.85.67.23