Please fill in all the fields of the form with English.
 請以英文填寫以下表格。多謝合作!
　
Customer Information 客戶資料 　
　
First Name:
名字*:  		　
Last Name:
姓氏*: 		　
Chinese Name:
中文姓名: 		　
Date of Birth:
出生日期: 		/ / (DD/MM/YYYY)
(日/月/年)
Sex:
性別: 		Male　 Female 　
Email Address:
電郵地址*: 		　
Address:
 地址: 		(flat, floor & block)
(單位,層數及座數)
　 (street & estate)
(街道名稱及屋苑)
　 (area)
(地區)
District:
區域:  		　
Home Phone No.:
住宅電話:   		 　
Office Phone No.:
辦工電話: 		　
Mobile/Pager No.:
手提電話/傳呼號碼: 		　
Fax No.:
傳真號碼: 		　
　 　 　
Product Information 產品資料 　
Shop's name*:
經銷商號名稱*:		 　
Machine Model No.*:
產品型號*:  		　
Machine Serial No.*:
機身編號(箂思康各項產品請輸入購買發票單號)*:  		　
Purchase Invoice Number*:
購買發票單號*:  		　
Date of Purchase*:
購買日期*:  		/ / (DD/MM/YYYY)
(日/月/年)
* These fields must be filled
* 這些項欄必須填寫
　
 
Free Warranty 免費保養 　
　
Thank you very much for purchasing COUNTRY CAPITAL TECHNOLOGY LTD. Product. This product will be entitled to a free repair period of twelve months(for all products) from the original date of purchase in accordance with the service terms and conditions.
多謝選購國都科技有限公司產品，根據服務條款，所有產品都有基本的12個月(產品由購買日期起開始計算)。
　
Important Notice 重要通告 　
　
A. The original Purchase Invoice and Label MUST be kept for our verification when repair is required.
請保存正本發票及標貼，留待產品保養維修時，出示以作核對及確認資料。
B. Application for free warranty registration MUST be submitted to us within 15 days from the original date of purchase. Any delay will make application invalid.
購買國都科技有限公司產品後，請於15天內，申請保養服務。如逾期申請將會作廢。
C. Applications MUST be supported by purchase evidence by sending us a copy of purchase invoice.
所有申請必須提交副本發票以作存核。
　
* Any query require contacts with Customer Service Hotline at 852-27303323 (by phone) or technical@country.com.hk (by email)
 * 如有任何查詢，請致電聯絡我們客戶服務熱線852-27303323或電郵致technical@country.com.hk。

Submit this form by clicking the Submit button below, and we will confirm your application by mail or email.
請按確認按鍵以提交申請表格，我們將以郵寄或電郵方式確實你的申請。