Elettrotecnica Grig s.r.l.

REGISTRATION FORM

Dear Customer, in order to to serve You promptly and accurately we considered the starred fields to be necessarily filled in. Nonetheless, we kindly ask You to fully compile this contact form to help us to improve the service.

Name *
Surname *
Email *
Job Title
Company Name*
Address *
City*
State/Province *
ZIP *
Country *
Phone *
Fax
Web Site

Category *
Company's turnover*		x year*
Total Purchase volume *		x year *
referable/ascribable to control panels
referable/ascribable to control electronic and control boards
N° Employees

Business area of highest interest
How did you know about our company?
Do you actually use our competitors' products?	(Yes= Selected)
If Yes, of which producer?
Which payment terms seem more suitable to your company profile?

Which delivery time meet best your needs?

Are you disposed to complete your purchase using electronic transaction processing (Credit Card/Paypal/Electronic funds transfer/etc.)?
	(yes = selected)

Notes

Elettrotecnica Grig S.r.l. peridiocally supplies newsletters and updates price lists. We kindly ask you to eventually subscribe the following options:

Newsletter Service
	I want to receive an email containg new products informations, new web pages, fairs and exhibition dates, etc.)
Update Price List Service
	I want to receive an email containg updated price lists and/or altered economical conditions highlights reserved to me.

I hereby authorize Elettrotecnica Grig S.r.l. to insert my data in the Customer's register for promotional, advertising and informative purpose. At any time and at no charge, in accordance with the law 675/96 art.13, I will be able to examine and modify my personal information as well as oppose to their utilization for such purpose
Autorization *

Fields marked with (*) are obligatory.