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Request form

Fill in all the input data in the request form to get our offer for a heat pump. Please remember to fill in your phone number so that our operator can approach you if necessary.

Object’s heat loss [kW]:
Heated area [m²]:
Number of floors:
Heating system:	radiator floor combined other
Your existing heat source:
Power of your existing heat source [kW]:
Requested type of heat pump:

Utilization of the heat pump
heating only	domestic hot water preheating	pool water heating	solar system connecting

		capacity in m³
	Supposed realization date

Name:
Address:
City:
E-mail:
Telephone:

Your further comments

I hereby grant my approval to process my personal data by course of law 101/2000 Sb., Of Personal Data Protection And Of Several Laws Modification, in the valid version, to this company: TC MACH, s.r.o. Maničky 5, 616 00 Brno (Company). I grant my approval to process my personal data I provided or am going to provide for marketing purposes (especially for marketing of the Company’s makes, products and services) in the extend necessary for fulfilling the specified purpose.

I hereby give my declaration statutory that the data I provided are true and precise. Without any further postponement, I will notify the Company provably of any changes in the data provided.

I am aware of the fact that my approval to process my personal data can be cancelled at any time. The personal data will be processed manually or by means of IT by special authorised personnel. The personal data will be kept safe in electronic or paper form with a restricted access of third parties.

Transcribe carefully the code from the picture:

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