| First Name* |
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| Family Name* |
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| Company* |
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| Address* |
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| P.O.Box* |
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| Zip Code |
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| Town* |
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| Region/Province* |
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| Country |
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| Telephone* |
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| Fax |
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| E-mail address* |
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| Company's Internet website |
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| How
do you want to be contacted? |
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| How you would describe
your Business*? |
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| Other comments |
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| What's your annual
turnover? |
|
Number of
Sales Staff, if any* |
|
Number of
Technicians, if any* |
|
How long have you
been
working in this field (years)?* |
|
|
| What
other brands are you currently dealing with? |
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| Which
could be the most interesting items for you among our production? |
|
|
(*)
Starred lines must be filled in
|