PERSONAL INFORMATION

FULL NAME:

(*)

COMPANY NAME:

(*)

ADDRESS:

(*)

P.O.BOX:

COUNTRY:

(*)

TELEPHONE:

(*)

EMAIL:

(*)

FAX:

COMPANY INFORMATION

FIELDS OF ACTIVITY:   

PRODUCTS / SERVICES:

COMPANY SIZE:

IS THERE AN IT DEPARTMENT IN YOUR COMPANY?  YES     NO

NUMBER OF SHOPS/STORES/OFFICES?  

DOES YOUR COMPANY HAVE A WEBSITE?  YES    NO

IF YES, PLEASE GIVE US YOUR WEB SITE'S DOMAIN NAME?    [e.g.  www.youraddress.com]

COMMENTS / INQUIRIES:

WHAT SERVICE ARE YOU INTERESTED IN?

CONSULTANCY SERVICES  E-COMMERCE  WEB SOLUTION