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Information which you will seize hereafter will be used by our company only for treatment of your orders and commercial actions, and will not be communicated to a third party.
File follow-up personn
Title Name* First name*
Telephone* Fax
Mobile Tel.  E-mail*
Web

Company
Legal Form*
Intercommunity VAT n° (C.E.E member only)
Company' Name *
Identification n°
Billing Address *
Post code*
City*
Country*
Delivery Address
(if different from billing address)
Postcode
City
Country

Main contact
Function First name Name Phone Number
Manager
Principal Buyer
Accounts Department
Please indicate the type of industry that most closely matches yours:*
Please indicate the types of customers you are dealing with:*
How many are employed by your company?
2009 Visiomed - Tous droits réservés - Reproduction interdite