Company Name:

Person to contact:

Telephone/Fax number

E-mail:

Company address

Street & number:

Code, residence:

Language for translation:

From which language to:

Subject to translate:

Number of pages:

Due date:

I/We agree to use our personal details for the needs of the c/o considering the legal rights dated 29th of August 1997 as per articles code number 133/883