Affiliation request - Luxanty

Affiliation request

Are you a private/a company? (compulsory)

Registered Name of the Company: (compulsory)
Company Type

VAT Registration Number (compulsory):
Company Address (compulsory)
Town (compulsory)
Legal Representative (compulsory)
Telephone Number (compulsory)
Company E-Mail (complulsory)
Chamber of Commerce Certificate (compulsory)
Name (compulsory)
Surname (compulsory)
Address (compulsory)
Town (compulsory)
Date of birth (compulsory)
Place of birth (compulsory)
Fiscal Code (compulsory)
Email: (compulsory)
Telephone number (compulsory)
ID or Passport (compulsory)
Association name (compulsory)
Indirizzo: (compulsory)
Town: (compulsory)
Fiscal Code (compulsory)
Email: (compulsory)
Telephone number (compulsory)

Bank coordinates (to pay provisions)

IBAN (international bank account number) or rechargeable card coordinates (compulsory)
Bank:

SPONSOR

Name Sponsor:
Sponsor's code number:


Tutti gli acquisti effettuati dopo il 1 Agosto saranno spediti a partire dal 26 Agosto. Buone Vacanze! Dismiss