ON LINE FORM
  
     
Surname * Name    
             
Address *  
                       
Zip Locality****
---Prov.**
       
             
Telephone * Fax            
                       
E-mail   Category            
                       
Interest in artist glass windows/fittings
destined to:		            
             
Messageoooo  
             
Preferabbly contact me at this time: eeeeeee of the days      
             
N.B.: the data marked with * must be obligatorily iserted.            
             
Seen the information contained in the art.13 of the Law 196/2003, I authorize the
handling of my personal data in compliance with the mentioned Law on Privacy.