Professional Documents
Culture Documents
APPLICATION FORM
_ 1 SOLITAIRE (Best seats in the house - first 4 rows, Exclusive briefing with Tony,
_ 1 GOLD (general):
_ 1 DIAMOND
(Seats in first rows, Exclusive briefing with Tony,
One meal supplied on Day 2,3,4, Relaxing mini-massage):
Payment
Participant
PERSONAL DATA
CREDIT CARD
Name
Type:
Surname
Owner
Date of birth
Profession
Valid until
________________
___/___/___ CV2 ___
(3 digits safety code printed on the back of your card)
Address
Zip code
City
SIGNATURE
(obligatory)
BANK TRANSFER _(please tick the box if you choose this option)
Country
Beneficiary
HIPERFORMANCE srl
ACCOUNT#
2849/74
Home Ph.
Office Ph.
Bank
Mobile Ph.
Fax nr.
Address
Iban
POSOIT22
Invoice
I request an invoice issued to:
(Invoice has to be requested within this form, by filling out all required data. If information is not complete, the invoice will be issued on behalf of the participant.)
Company name
VAT nr.
________________
n
Address
Zip code
City
Country
2/10
Date
Date
Hi-Performance srl - Via Federico Cesi, 72 - 00193 Rome - ITALY Tel: +39 06 36005152 - Fax: +39 06 36000752 - E-mail: info@hiperformance.it - www.hiperformance.it
2/12
Legible Signature