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Company		*
Second name of the managing director		*
First name of the managing director		*
Adress		*
Postal code		*
City		*
Telephone number		*
Fax number		*
Email address		*
Web site
Date of creation
Registration number		*

Type and number of vehicles (more information about the type of vehicles) :
		Type 1 : vehicle(s) Type 2 : vehicle(s) Type 3 : vehicle(s) Type 4 : vehicle(s) Type 5 : vehicle(s) Type 6 : vehicle(s) Type 7 : vehicle(s) Type 8 : vehicle(s)

I confirm hereby that our company respects the transport regulations (please send your copy of vehicle insurance, good in transit insurance, public and employer liability insurances).

Your message
		* obligatory fields



Please also provide information about your company on the form attached. > The document