Trade Name     Product Family*  
Surname*     Product*  
Name*      
Date of Birth [MM/DD/YYYY]     Purchasing Date [MM/DD/YYYY]*  
Address*     Where Purchased*  
House number*     Serial Number*  
Post Code*     Purchase Price (to nearest £1)*  
Town*     Were you given or did you purchase an extended guarantee ?  
Province/State*     If yes, for how long (year)?  
Country*      
Telephone*      
E-mail*      
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 

I agree about the use of my personal data for contact purposes 

I authorize the use of my data for promotional purposes of the offered products and services 

I authorize to communicate my data to commercial partners for promotional purposes of the offered products and services