Title of your request

Removal or intervention Address			Delivery or Installation Address
Town/City :		Dept. :	Town/City :		Dept. :
Date :	/ /		Date :	/ /

Type of intervention (Tick the block which corresponds)
Transport	Hiring of a crane / lifting handling	Transport + Lifting

Load
Specify	Characteristics L x B x H in mm Weight per unit in tons Quantity

Observations

Crane hire
Type of crane and capacity required:
Hiring period:

Any other specifications such as the height available, range, any limitations.

Details
Company:		Tel.:
Address:		Fax:
Person to contact:		E-mail:
Delay of response:

In accordance with the Loi Informatique et Libertés of 6 January 1978 (Information technology and Freedoms law)
one disposes of the right to access and rectify any information pertaining to one's own subject.

Any information addressed to the attention of our company or association shall remain solely in our possession.

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	155, rue Fontenailles - 71000 MACON FRANCE Tel : +33 (0) 3 85 34 17 94 - Fax : +33 (0)3 85 29 18 67 M@il : mailto:p.couturier@tmccouturier.fr