Trade in Ministry of Haelth
Medical Device classified 1

Registration

Personal data

E-Mail

Password Seen password

Surname

Name

Fiscal Code

Place of birth

Date of birth

Address

City

Postal code

Telephone number

Name of the company /Doctor

Number TVA

Fiscal code

Address

City

Postal code

Email to send invoice

Professions / Disciplines

Professional Order

Registration number for the Professional Order

Province / Region for Professional Order

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For the sending of communications concerning informative and/or commercial and/or promotional messages

I give my consent to the processing of my personal data as privacy policy

I accept the General conditions of the contract

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