Request a quote

1. Customer data

Company Name

Contact person (Optional)

Phone

E-mail address

2. Car data

Brand

Model

License Plate

What is the problem of the belt tensioner(s)?

Number of belt tensioner(s)

Location of seat belt pretensioners?

Would you like an appointment in Cuijk?
YesNo

Would you like to have the belt tensioner(s) installed and removed by Airbagbank?
YesNoOntzichtbaar

What is the capital of the Netherlands? (spam prevention)

Questions about the form?

+31 (0)485-331199

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