Name* Surname*
Address Zip code
City State
Telephone* Cell
Fax E-mail*
Rif. Request*
* Obligatory

According to the law 196/03 and art. 11 of the law 675/96, providing legal protection to persons and other subjects regarding treatment of personal data , the applicant provides to the person responsible for the privacy, the consent to use their personal data, directly or also through third parties, to comply to obligations regarding the law, regulations or community normative, also for the following purposes:[Read]
I declare to have read and accepted the terms of the information regarding privacy

rewrite the displayed code