Title* .... Mr. Ms.
Title .... Dr. Prof. Ing. Dipl.Ing Dr.Dr. Prof.Dr.
Surname*
First name*
Date of birth* ... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ... Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec ... 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Street / Street No.*
Building
Postcode & City*
Country* .... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Diego Garcia Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Dem. People's Republic Kosovo Kuwait Kyrgyzstan La Réunion Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of North Macedonia Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Martin Saint Pierre et Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Lucia Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Maldives Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkmenistan Turks and Caicos Islands Tuvalu Türkiye USA Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, U.S. Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Ċland Islands
Phone no.* ... AFG: +93 AL: +355 DZ: +213 AND: +376 ANG: +244 ANT: +1268 RA: +54 AM: +374 AW: +297 AUS: +61 A: +43 AZ: +994 BS: +1242 BH: +973 BD: +880 BDS: +1246 BY: +375 B: +32 BZ: +501 BJ: +229 BM: +1441 BHT: +975 BOL: +591 BIH: +387 BW: +267 BR: +55 VG: +1284 BRU: +673 BG: +359 BF: +226 BI: +257 K: +855 CAM: +237 CAN: +1 CV: +238 KY: +1345 CF: +236 TD: +235 RCH: +56 CN: +86 CO: +57 KM: +269 CG: +242 CD: +243 CR: +506 CI: +225 HR: +385 CU: +53 CY: +357 CZ: +420 DK: +45 DJ: +253 DM: +1767 DOM: +18 EC: +593 EG: +20 SV: +503 GQ: +240 ER: +291 EST: +372 ETH: +251 FK: +500 FO: +298 FJ: +679 SF: +358 F: +33 GF: +594 PF: +689 GA: +241 GM: +220 GE: +995 D: +49 GH: +233 GBZ: +350 GR: +30 GL: +299 GD: +1473 GLP: +590 GCA: +502 GG: +44 GN: +224 GW: +245 GUY: +592 RH: +509 HN: +504 HK: +852 H: +36 IS: +354 IN: +91 RI: +62 IR: +98 IQ: +964 IRL: +353 GBM: +44 IL: +972 I: +39 JA: +1876 J: +81 JEY: +44 JO: +962 KZ: +7 7 KE: +254 KI: +686 KWT: +965 KG: +996 LA: +856 LV: +371 RL: +961 LS: +266 LR: +231 LY: +218 FL: +423 LT: +370 L: +352 MAC: +853 MK: +389 RM: +261 MW: +265 MAL: +60 MV: +960 ML: +223 MT: +356 MH: +692 MTQ: +596 MR: +222 MS: +230 YT: +262 MEX: +52 FSM: +691 MD: +373 MC: +377 MN: +976 ME: +382 MA: +212 MZ: +258 MM: +95 NA: +264 NR: +674 NP: +977 NL: +31 NC: +687 NZ: +64 NI: +505 NE: +227 NG: +234 PRK: +850 N: +47 OM: +968 PK: +92 PW: +680 PA: +507 PG: +675 PY: +595 PE: +51 RP: +63 PL: +48 P: +351 PR: +1 QA: +974 REU: +262 RO: +40 RUS: +7 RW: +250 BL: +590 KN: +1869 WL: +1758 MF: +590 PM: +508 VC: +1784 WS: +685 SM: +378 ST: +239 SA: +966 SN: +221 RS: +381 SY: +248 SL: +232 SGP: +65 SK: +421 SLO: +386 SB: +677 SO: +252 ZA: +27 ROK: +82 E: +34 LK: +94 SD: +249 SR: +597 SZ: +268 S: +46 CH: +41 SYR: +963 TW: +886 TJ: +992 TZ: +255 THA: +66 TL: +670 TG: +228 TO: +676 TT: +1868 TN: +216 TR: +90 TM: +993 TC: +1649 TV: +688 UG: +256 UA: +380 UAE: +971 GB: +44 USA: +1 RDU: +598 UZ: +998 VU: +678 VA: +39066 VE: +58 VN: +84 WF: +681 EH: +212 YE: +967 ZMB: +260 ZW: +263 -
Mobile* ... AFG: +93 AL: +355 DZ: +213 AND: +376 ANG: +244 ANT: +1268 RA: +54 AM: +374 AW: +297 AUS: +61 A: +43 AZ: +994 BS: +1242 BH: +973 BD: +880 BDS: +1246 BY: +375 B: +32 BZ: +501 BJ: +229 BM: +1441 BHT: +975 BOL: +591 BIH: +387 BW: +267 BR: +55 VG: +1284 BRU: +673 BG: +359 BF: +226 BI: +257 K: +855 CAM: +237 CAN: +1 CV: +238 KY: +1345 CF: +236 TD: +235 RCH: +56 CN: +86 CO: +57 KM: +269 CG: +242 CD: +243 CR: +506 CI: +225 HR: +385 CU: +53 CY: +357 CZ: +420 DK: +45 DJ: +253 DM: +1767 DOM: +18 EC: +593 EG: +20 SV: +503 GQ: +240 ER: +291 EST: +372 ETH: +251 FK: +500 FO: +298 FJ: +679 SF: +358 F: +33 GF: +594 PF: +689 GA: +241 GM: +220 GE: +995 D: +49 GH: +233 GBZ: +350 GR: +30 GL: +299 GD: +1473 GLP: +590 GCA: +502 GG: +44 GN: +224 GW: +245 GUY: +592 RH: +509 HN: +504 HK: +852 H: +36 IS: +354 IN: +91 RI: +62 IR: +98 IQ: +964 IRL: +353 GBM: +44 IL: +972 I: +39 JA: +1876 J: +81 JEY: +44 JO: +962 KZ: +7 7 KE: +254 KI: +686 KWT: +965 KG: +996 LA: +856 LV: +371 RL: +961 LS: +266 LR: +231 LY: +218 FL: +423 LT: +370 L: +352 MAC: +853 MK: +389 RM: +261 MW: +265 MAL: +60 MV: +960 ML: +223 MT: +356 MH: +692 MTQ: +596 MR: +222 MS: +230 YT: +262 MEX: +52 FSM: +691 MD: +373 MC: +377 MN: +976 ME: +382 MA: +212 MZ: +258 MM: +95 NA: +264 NR: +674 NP: +977 NL: +31 NC: +687 NZ: +64 NI: +505 NE: +227 NG: +234 PRK: +850 N: +47 OM: +968 PK: +92 PW: +680 PA: +507 PG: +675 PY: +595 PE: +51 RP: +63 PL: +48 P: +351 PR: +1 QA: +974 REU: +262 RO: +40 RUS: +7 RW: +250 BL: +590 KN: +1869 WL: +1758 MF: +590 PM: +508 VC: +1784 WS: +685 SM: +378 ST: +239 SA: +966 SN: +221 RS: +381 SY: +248 SL: +232 SGP: +65 SK: +421 SLO: +386 SB: +677 SO: +252 ZA: +27 ROK: +82 E: +34 LK: +94 SD: +249 SR: +597 SZ: +268 S: +46 CH: +41 SYR: +963 TW: +886 TJ: +992 TZ: +255 THA: +66 TL: +670 TG: +228 TO: +676 TT: +1868 TN: +216 TR: +90 TM: +993 TC: +1649 TV: +688 UG: +256 UA: +380 UAE: +971 GB: +44 USA: +1 RDU: +598 UZ: +998 VU: +678 VA: +39066 VE: +58 VN: +84 WF: +681 EH: +212 YE: +967 ZMB: +260 ZW: +263 -
E-Mail*
Personal tax number*
These information are necessary only if you are a corporate customer and the invoice address differs from your private address.
Company name 1
Company name 2
Company name 3
Cost Center
CD number**
Street / Street No.
Postcode / City
Country .... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Diego Garcia Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Dem. People's Republic Kosovo Kuwait Kyrgyzstan La Réunion Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of North Macedonia Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Martin Saint Pierre et Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Lucia Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Maldives Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkmenistan Turks and Caicos Islands Tuvalu Türkiye USA Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, U.S. Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Ċland Islands
Phone no. ... AFG: +93 AL: +355 DZ: +213 AND: +376 ANG: +244 ANT: +1268 RA: +54 AM: +374 AW: +297 AUS: +61 A: +43 AZ: +994 BS: +1242 BH: +973 BD: +880 BDS: +1246 BY: +375 B: +32 BZ: +501 BJ: +229 BM: +1441 BHT: +975 BOL: +591 BIH: +387 BW: +267 BR: +55 VG: +1284 BRU: +673 BG: +359 BF: +226 BI: +257 K: +855 CAM: +237 CAN: +1 CV: +238 KY: +1345 CF: +236 TD: +235 RCH: +56 CN: +86 CO: +57 KM: +269 CG: +242 CD: +243 CR: +506 CI: +225 HR: +385 CU: +53 CY: +357 CZ: +420 DK: +45 DJ: +253 DM: +1767 DOM: +18 EC: +593 EG: +20 SV: +503 GQ: +240 ER: +291 EST: +372 ETH: +251 FK: +500 FO: +298 FJ: +679 SF: +358 F: +33 GF: +594 PF: +689 GA: +241 GM: +220 GE: +995 D: +49 GH: +233 GBZ: +350 GR: +30 GL: +299 GD: +1473 GLP: +590 GCA: +502 GG: +44 GN: +224 GW: +245 GUY: +592 RH: +509 HN: +504 HK: +852 H: +36 IS: +354 IN: +91 RI: +62 IR: +98 IQ: +964 IRL: +353 GBM: +44 IL: +972 I: +39 JA: +1876 J: +81 JEY: +44 JO: +962 KZ: +7 7 KE: +254 KI: +686 KWT: +965 KG: +996 LA: +856 LV: +371 RL: +961 LS: +266 LR: +231 LY: +218 FL: +423 LT: +370 L: +352 MAC: +853 MK: +389 RM: +261 MW: +265 MAL: +60 MV: +960 ML: +223 MT: +356 MH: +692 MTQ: +596 MR: +222 MS: +230 YT: +262 MEX: +52 FSM: +691 MD: +373 MC: +377 MN: +976 ME: +382 MA: +212 MZ: +258 MM: +95 NA: +264 NR: +674 NP: +977 NL: +31 NC: +687 NZ: +64 NI: +505 NE: +227 NG: +234 PRK: +850 N: +47 OM: +968 PK: +92 PW: +680 PA: +507 PG: +675 PY: +595 PE: +51 RP: +63 PL: +48 P: +351 PR: +1 QA: +974 REU: +262 RO: +40 RUS: +7 RW: +250 BL: +590 KN: +1869 WL: +1758 MF: +590 PM: +508 VC: +1784 WS: +685 SM: +378 ST: +239 SA: +966 SN: +221 RS: +381 SY: +248 SL: +232 SGP: +65 SK: +421 SLO: +386 SB: +677 SO: +252 ZA: +27 ROK: +82 E: +34 LK: +94 SD: +249 SR: +597 SZ: +268 S: +46 CH: +41 SYR: +963 TW: +886 TJ: +992 TZ: +255 THA: +66 TL: +670 TG: +228 TO: +676 TT: +1868 TN: +216 TR: +90 TM: +993 TC: +1649 TV: +688 UG: +256 UA: +380 UAE: +971 GB: +44 USA: +1 RDU: +598 UZ: +998 VU: +678 VA: +39066 VE: +58 VN: +84 WF: +681 EH: +212 YE: +967 ZMB: +260 ZW: +263 -
Business e-mail
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Credit Card No.*
Credit card .... Eurocard/Mastercard Visa (credit card) American Express Diners Club Discover Card JCB Credit Card
Valid until ... Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec .... 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035
Driving licence no.*
Place of issue*
Issue date* .. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ... Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec .... 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
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