HORIZONTE Partner Programme
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Contact Information
Name of Company
:
Contact Person
Title
*
Mr
Ms
First Name
:
*
Family Name
:
*
Address
:
*
Zip / City
:
*
Country
:
*
Phone
:
Fax:
E-mail:
*
E-mail
(please repeat)
:
*
Payment Information
Account Holder
:
*
Account Number
:
*
BLZ (German bank code)
:
Bank Name:
*
IBAN:
*
SWIFT-BIC:
*
Your Website
URL of yourWebsite:
*
Number of visitors
per month :
< 1.000
1.000 - 5.000
5.000 - 10.000
10.000 - 50.000
50.000 - 200.000
> 200.000
Content of your website:
Your access information
Password:
*
Password
(please repeat)
:
*
More information
I have read and accept the terms of the contract.
(
see General Conditions of our Partner Programme
)
