First name: *
Last name: *
Company name: *
Street: *
Number: *
Town: *
Postal code: *
Phone no.: *
Mobile phone no.:
E-mail:
Sex: Female Male

1. Activity type *
Construction/construction and repair enterprise
Building materials wholesale depot/store
Dealer of a window and door joinery manufacturer
Other, please specify the type:

2. Scope of operation *
Company operating within a local (poviat) range
Company operating within a local (provincial) range
National scale operation
Other, please specify the type:

3. Company size *
Individual activity
Company employing up to 5 persons
Company employing from 6 to 15 persons
Company employing more than 16 persons
4. To what extent, according to you, does the contractor/wholesaler influence the investor's decision on the choice of the external roller blind and garage door systems? *
0 % 25 % 50 % 75 % 100 %
5. Please specify the group of products manufactured by Mirola your company may be interested in *
External roller blinds
Garage doors and industrial gates
Window sills
6. Please specify the preferred form of contact from Mirola *
e-mail post phone meeting
I hereby consent to entering my personal data to the Mirola company's database and their processing for marketing purposes by Mirola SP.J, address: Mikołowska 129, 43-180 Orzesze, in accordance with the provisions of the law of personal data protection (Journal of Laws of 1997, no. 133, item 883). I have provided the above data of my own free will and I have been informed of the right vested to me to access and correct them.*
I hereby consent to receiving commercial information at my e-mail address and mobile phone number in accordance with the law of services provision by electronic means of 18th February 2002.