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PERSONAL DATA OF THE LICENSEE

Company

Department

Licensee type

Salutation

First Name

Last Name

Address

Zip Code

City

Country

Home Phone

Website

PERSONAL DATA OF APPLICANT

Is the licensee also the applicant?

If the licensee is not the applicant, please also provide the contact details of the applicant.

Company Applicant

Department Applicant

Applicant type

Salutation Applicant

First Name Applicant

Last Name Applicant

Adress Applicant

ZIP Applicant

City Applicant

Country

Email Applicant

INFORMATION FOR THE LICENSE AGREEMENT

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Type of final goods

Name of the company who is placing the final goods on the market

Produced Article Amount (Pieces)

Produced Textile (Indication meter or kilogram)

Country of production, where chemical is applied

Ordered Quantity of RUDOLF Products & Name*

Chemical sourcing from

Distributor (Company)

Message

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