NAME:

In case of wrong input it's possible to repeat the input pushing CANCEL
FAMILY NAME:
COMPANY:
PRIVATE TRADER WHOLESALER

STREET:

TOWN:
REGION:
TELEPHONE:
FAX:
MOBIL PHONE:
E-MAIL:
COMMENTS:

INFORMED CONSENT REQUIRED BY "PRIVACY" LAW 675/96:
In execution of Art. 11 of Law 675/96 that protects the right to privacy of individual and corporate persons in the processing of personal data, the undersigned provides consent for the processing of his/her own personal data whether directly or indirectly through third parties for the following purposes: statistical and market research, the transmission of advertising and informative material, direct sales activity or direct product and/or service positioning, and the transmission of commercial information and interactive commercial material. The undersigned understands that this consent can be withdrawn in any moment whatsoever and therefore deny consent for the processing and use of personal data. 

Yes, I hereby grant my consent
No, I hereby not grant my consent