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Information Request Form
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NAME*
LAST NAME*
COMPANY
ADDRESS LINE 1*
ADDRESS LINE 2
CITY*
ZIP CODE
PHONE NUMBER
FAX NUMBER
E-MAIL*
MESSAGE*
* ENTER THE CODE THAT APPEARS IN THE IMAGE ABOVE
PRIVACY
Data sent via this form is collected, recorded, stored and managed in order to make business activities possible i.e supply of goods and services, in accordance with art. 13 of Law 196/2003. At any time, in accordance with art. 7 and 8 of this Act, you can have access to your data, request modification, deletion or integration, or deny any use by writing to L'incontro Uomo - c.so Duomo 44/46 – 4110 Modena - phone 059 211681 L'incontro Donna - via castelmaraldo 1 - 41100 Modena – phone 059 243108
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AUTHORIZE THE PROCESSING OF PERSONAL DATA