Form for new Partners

If you intend to become a Partner, you must complete this form. If you have made the request to become a Partner but not yet received your data, you can also request them here, filling the "Comments" field with that indication. After submitting the form you will receive in your email inbox a message with the instructions of the following steps.


Name *

Address *

City *

Postal Code *

Number of IC / Citizen Card *

Date of birth *



Tax Identification Number (TIN / LPN) *

Phone number

Cell Phone number *

Email *