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  COMPANY  * NAME AND SURNAME
  ADDRESS   TELEPHONE
  CAP   FAX
  CITY   MOBILE
  PROVINCE   * E-MAIL
  STATE
  * REQUIRED FIELDS
  NOTES


The Customer states its knowledge of the privacy law in accordance with Article 13 D. lgs 30th June 2003, n.196 and following modifications, and authorizes Eurorossi S.a.s. to the use of its personal data.


                                          Eurorossi s.a.s. di Rossi Daniele e Franzon Ornella & C.    Ceggia (VE) - ITALY Tel/Fax +39 0421 329595   
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