Full company name and type of business:*

Tax Identification Number:*

Company headquarters:*

Type of point of sale:*
—Proszę wybrać opcję—PharmacyMedical / herbal storeHealth food storeCosmetic shop / drugstoreShop with natural cosmeticsOther (enter in the field below)

Do you have stationary sales?:*
YesNo

Name of the point and address at which SYLVECO products will be sold:

Do you sell online?:*
YesNo

Your store's website:

First and last name, contact phone number and e-mail address of the person responsible for starting cooperation and ordering:*

First and last name, contact phone number and e-mail address of the person responsible for payment:*

Company bank account details (bank name, account number):*

Message:*

Contact email address:*

*Required fields

In accordance to article 6 clause 1 lit. a) of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) (Text with EEA relevance), I consent to the processing of my personal data such as: name, surname, telephone number, e-mail address, in order to use the Contact Form and receive commercial information, other materials promotional, advertising and marketing from SYLVECO Piela Radosław with headquarters in 36-004 Łąka 260F, Poland. Information about my rights and obligations in connection with the processing of personal data can be found in the Privacy Policy and the GDPR.