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Become distributor

Contact
Company *
Commercial Trade mark *
Affiliation trade mark *
Fiscal form   
With a capital of (euros) *
Enrollment *
Company address   
Postal Code   
City   
Country   
Creation date   
Phone Number   
Fax number   
Employees   
Private data
Last Name *
First Name   
Function   
Email *
Shop informations
Surface of the shop (m²)   
Surface for Hector Saxe (m²)   
Front view (metric system)   
Influence around (km)   
To open now or in few months   
Choice of products I want to resell in my sector
Backgammon
Cases checkers
Machines and electronic games
Tables
Coffrets de roulette
Game mat
Complementary informations
Observations   

Asterisked fields are compulsory.