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On-line Registration

Complete the form below to order any of our services:

Registration form Wimax On Line


Name:


Surname:	(Only individuals)


DNI / CIF:	Ej: 12345678X / X12345678


Contact:	(Only companies)


E-mail:


Fax:


Web page:


Phone:


Alternate Phone:


Via:	Ej: Street, road, sidewalk...


Via name:


N° / Letter:	Ej: 2, P, s/n


Postcode:


Town:


Province:


Alternate address:

Via:	Ej: Street, road, sidewalk...


Via name:


N° / Letter:	Ej: 2, P, s/n


Postcode:


Town:


Province:


How did you find us?:


What service do you want?:


Second residence offer:


Comments:

I accept the Data Protection Policy Basic information about data protection - Responsable: WIMAX ON LINE SL. Purpose: Process your registration as a client. Legitimation: Execution of the contract. Recipients: We do not communicate your data. Rights: You can access, rectify, delete your data, and exercise other rights. Additional information: You can consult additional information by accessing our Data Protection Policy at www.wimaxonline.es.

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