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City

Postal Code

Name

Surname

Mobile No.

Email Id

Activity Type
ShopCafeSupplierDistributor

No. of Coffees per day
1-33-55-77-99-11Above 12

Are You Already Open?YesNo

Outlet / Shop Name

Current Supplier

Address    

I have taken note of the information and understood it, aware that for the purposes referred to in point 2 letter. A, D and E the legal basis is different than consent.