Form for special request

Collection date DD/MM/YYYY* Firstname*

Locality of collection (town, station, adress ecc.)** Surname*

Locality of destination (town, station, adress ecc.)*

Number of persons* E-Mail*

Return collection date (only for go and back)

Note

Privacy conditions, D.Lgs. 196/03** 

(*) Required field

(**) With reference to the legislation on privacy and its conditions informativa sulla privacy i consent to the treatment of my personal details solely for purposes connected with and instrumental to the management of the business; for thes I hereby authorise their release.