Fluke DTX 1800 Certifier

I want this equipment from: *

Until: *

Requester name: *

Requester email: *

Basque vocational training centre: *

Email of Head of Institution:
Who will authorize the application process.

Centre address:
In this address will be executed delivery of the equipment (center address, city, postal code).

Usage that will be given to the equipment:

I agree to the personal data clause below*
The data provided will be used solely and exclusively for the purposes of the procedure or action in question. In any case, those data will be processed or assigned to third parties except with the consent of the affected, or in the cases provided for in Articles 6.2 and 11.2 of Law 15/1999 of 13 December, Protection of Personal Data (BOE n º 298 of December 14, 1999). In compliance with the provisions of the Law 15/1999, the individual donor data may at any time exercise their rights of access, rectification, cancellation and opposition as determined by regulation.