First Name *:

Last name *:

Job Title:

Company*:

Manufacturer

Integrator

Other

Address *:

City *:

State *:

Zip Code* :

Country *:

Telephone *:

Fax:

E-mail address*:

Select:

Select:

Date:

Date:

Hospitality/Retail

Electro-Medical

Fiscal

EFT PoS

Gaming/Lottery

Gas pumps

Kiosks

Automotive

Vending

ID Automation
Instrument analyses

Voting

OEM

Other

No

Comments

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Personal data treatment in accordance with D.I. n. 196 law, art. 13, June 30th 2003.

I authorize

PRIVACY PROTECTION LAW - Law n. 675/96. Your personal data is stored in a database and will be used for the sole purpose of executing the present service. Failure to supply data will result in the non-execution of the service. Your personal data can be transmitted as prescribed by the law. The holder of your personal data is APS Industrial s.r.l. Via delle Scienze, 10 Binasco - Milan (Italy). You have the right to access, correct, cancel or oppose the storage of your personal data etc. by contacting APS headquarter.