Company name [Type your company name here] First and last name [Type your first and last name here] Address [Type your company's full address here]

Telephone [Enter telephone number here] Telefax [Enter fax number here] E-mail [Enter email address here]

Registration in the commercial register Registration court [Enter the competent registration court here] Registration number [Enter the registration number here]

Tax identification number [Enter the tax identification number here]

Business Identification Number [Type business identification number here]

Inspection [Write here the competent inspection court]