First Name * |
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Last Name * |
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Identity Card Serial and
Number(if company, leave blank) |
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Company Name (if private
person, leave blank) |
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Telephone * |
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Fax * |
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Address * |
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City * |
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Country * |
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Contact / Company E-mail * |
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Contact / Company Website
(if any) |
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Job Position (if private
person, leave blank) |
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Fiscal Code (if private
person, leave blank) |
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Registry of Commerce code
(if private person, leave blank) |
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Bank Name |
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Bank IBAN Account |
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Type of product / service
required * |
|
Subscription type * |
|
Installation location(s) * |
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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* |
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Insert security code |
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