Name of the company / business name (as per the commercial register / business licence):

Registered seat / place of business (as per the commercial register / business licence):

Specification of the product / service:

Contact person (name and surname):

Phone:	Fax:	Phone:
E-mail:	Web:

Existing commercial operations - number, location, line of business + photo documentation:

Anticipated date and time of sale opening: date 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 2010 2011 2012 2013

Requested space area (m2):