RICARICA, CARGO & OTHER APPLICATION FORM

Informazione Di Cliente

SL No. Details Information
1 Company/Shop Name
2 Company/Shop Address
3 Company/Shop Postal Code
4 Company/Shop Province
5 Company/Shop City
6 Company/Shop Country
7 Company/Shop Phone
8 Company/Shop Mobile
9 Owner Name
10 Date of Birth (DD/MM/YYYY)
11 Resident Card Number
12 Resident Issue Date (DD/MM/YYYY)
13 Resident Expire Date (DD/MM/YYYY)
14 Codice Fiscal
15 Resident Address
16 Resident City
17 Mobile
18 Email
Carta di Identità - P. Soggiorno / National identity card :
Codice fiscal :
Shop License :