| First Name * |
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| Last Name * |
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| Identity Card Serial and
Number(if company, leave blank) |
|
| Company Name (if private
person, leave blank) |
|
| Telephone * |
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| Fax * |
|
| Address * |
|
| City * |
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| Country * |
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| Contact / Company E-mail * |
|
| Contact / Company Website
(if any) |
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| Job Position (if private
person, leave blank) |
|
| Fiscal Code (if private
person, leave blank) |
|
| Registry of Commerce code
(if private person, leave blank) |
|
| Bank Name |
|
| Bank IBAN Account |
|
| Type of product / service
required * |
|
| Subscription type * |
|
| Installation location(s) * |
|
| Do you need Lamit 2Pro
Server/Router/Accelerator ? * |
|
| How many PC's do you plan to
sustain with our connection ? * |
|
| Will you use VoIP or VPN ?
(if yes specify details)* |
|
| Using the connection for * |
|
| Type of contract desired
(leasing and monthly rates, only for Romania) * |
|
| Forward your message to * |
|
| How did you hear about us ?
(please be specific) * |
|
| Other Comments* |
|
| Insert security code |
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