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Buyer Registration Form

Fields highlighted with a red asterisk * are mandatory
Last Name * :
 First Name :
Trading Name of Retail stores * :

Other Brands Sold :
 Type of stores * :

Downtown Boutique in dept. store
Shopping centre Other

Number of stores :
Address * :
 City * :


State :
Country * :
 Post code :
Telephone : 
 Mobile : 
e-mail * : 

Web site:
 Other Relevant Information :


PRIVACY POLICY - Data is collected with the sole purpose of offering our services. They will not be sold, exchanged, shared or released to third parties under any circumstance. You may exercise your right to review, modify or have any data deleted by contacting directly Via ROMA 15 s.r.l. or by using this form.

Data is provided on a discretionary basis, except where the user must specify a defined system behaviour (such as the issuance of newsletters). The non-submittal of information has no negative consequences, aside from the eventual impossibility to provide the indicated service.

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