Trade Name				Product Family		Irons with boiler Vaporella Boards Steam cleaners Vaporetto Steam + vacuum Vaporetto Lecoaspira Vacuum cleaner Lecologico Other vacuum cleaners Coffee machines Accessories Else
Surname*				Product
Name*				Purchasing Date [MM/DD/YYYY] [MM/DD/YYYY]
Address				Where Purchased
N.				Serial Number
ZIP Code				Issue's Text*
Town				Have you already been to a Service Center?		YES     NO
Province/State				If you have, where?
Country		France Germany Italy Mexico Other countries Portugal Romania Spain United Kingdom		When did you bring the product to the Service Center? [MM/DD/YYYY] [MM/DD/YYYY]
Telephone				Receipt number of the Service Center
E-mail*				Do you have other Polti products?		YES     NO
				If you do, which ones?
Privacy and sale general conditions. D.lgs.196/03. Privacy Policy, under art.13 D.Lgs.196 of 2003 June 30, concerning rules about " Protection of persons and other entities respect to the processing of personal data". We inform you that data relating to you that you provide us, are subject to the treatment respecting the above mentionned law and arising obligations and confidentiality. All your data are going to be stored at our facility and are going to be used only for institutional purposes, striclty linked to our job, as statistical processing, marketing and promotional activities etc. You can naturally exercise your right under art.7 D.Lgd 196 of 2003 June 30 (access,correction,deletion,opposition to treatment) contacting Polti Spa I certify that I know privacy policy   YES    NO    I agree about the use of my personal data for contact purposes   YES    NO    I authorize the use of my data for promotional purposes of the offered products and services   YES    NO    I authorize to communicate my data to commercial partners for promotional purposes of the offered products and services   YES    NO
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