Form of order

Insertion of the data of the Customer

Name of the Company (if the client is a Company): 

Surname*: 

Name*: 

Vat code/fiscal code (If the client is a Company):

 

Street*: 

Number*: 

City/urban district/rural district*: 

State/province/region*: 

Zip code/code postal*: 

Nation*: 

         e-mail*: 

Telephone: 

Cellular telephone: 

Fax: 

Web:

The safeguard of the personal data is guaranteed from the D.givo 196/2003 of the legislation of the Italian Republic for the safeguard of the privacy.

You now insert an User-id and a password for the consultation of your control panel: 

User ID*: 

For Your safety, uses a password not used in other internet services.

Password*: 

Confirmation of the password*:

The marked fields with * are obligatory.

Name of the product that you want to purchase*

Company that sells the product*

Quantity*: 

Forwarding charges: (the cost depends on the country where to send)*

Have you read the conditions of sale of the Company?*

To proceed to the purchase is obligatory the choice: "Yes, I have read the conditions"

To read the conditions of sale and guarantee of the Company  Press Here

Form of payment choice: (credit card, bank transfer, money orders, withdrawal to the store)* 

If the form of payment choice is the credit card ( VISA - MasterCard - PostePay), you will be transferred on a protected connection SSL

Company that is owner of this virtual shop: 

The marked fields with * are obligatory.

 

Ghielmetti Massimiliano.   Partita Iva : 04931130969   Cod. Attività: 620909