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Recording permanent data

ADLER SAS. is glad to make your acquaintance..
On filling in the form below, you'll allow us to ensure the service you wait
Adler SAS sells exclusively to professional customers. Private persons are welcome to contact us to get the coordinates of a distributor, in their country.
Attention : don't forget to click on "record" at the end of the form. Thanks.
The fields with * are mandatory.

  FIRM 

*

  Activity 


 autre :

CEE N° (car)  

EXECUTIVE 
name  

 Mr, Mrs, Ms ...
*
telephone number  
*
fax number  

email  

*
Would you like to receive our promotion by mailing ?  
email  

Yes :   No :
   HEAD OFFICE     
Address street   *
City  *
 Post code / Country   PC   *
Country
 
   DELIVERY     Permanent address
Address street  
City 
 Post code / Country   PC  
Country
telephone number 
fax number 
For a particular address linked to an order, fill in the boxes at the end of your order..
 
   INVOICING   Permanent address
Address street  
City 
 Post code / Country    PC  
Country
 
  PAYMENT 
Bank account number  

  
Your paying conditions

Delay :   Payment method :

  OPTIONAL  
Could you list usual suppliers ?
How did you first get in touch with ADLER SAS ?

 
 

Please, click on the icon after "record"

record    
 



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