The network of affiliated companies will record and process the data you provide in IT systems. We can assure you that we abide strictly by all the terms of the Federal Data Protection Act (BDSG) when handling any personal data which you provide and which we save in our mutual interests for further business transactions.
Firm name: (Mandatory field)
Street: (Mandatory field)
House number: (Mandatory field)
Postcode: (Mandatory field)
Town/city: (Mandatory field)
Country: (Mandatory field)
Title: Mr Ms
Department:
Forename: (Mandatory field)
Surname: (Mandatory field)
Phone: (Mandatory field)
Email address: (email address mandatory)
Inquiry number:
Supplier number:
Subject of the inquiry: Please select. BIRKOSIT Dichtungskitt LINSEED OIL VARNISH BIRKOSIT Dichtungskitt and LINSEED OIL VARNISH (Mandatory field)
Your message: (Mandatory field)
Request for quotation: Please email me Please telephone me Please arrange an appointment for me to visit in person Please do not fill out this field (spam protection)!
By submitting this form, you consent to the processing of your personal data for the purpose of contacting you. Further information can be found in our data protection declaration.
General Agency in Belgium
