Application for discount card

Name and surname*
Personal code*
Post address*
(street or plot/farm, house number and/or flat number, city/borough, town, village, municipality, county)
Zip code*
Phone*
E-mail*
Please issue discount cards as follows
Information to be printed on a discount card (name and surname of the user)
Notices
CAPTCHA
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AS Elenger Grupp issues a discount card by regular post within a week to the postal address indicated in the application.

To order the discount card please complete the application in the adjoining form.

Information to be printed on a discount card (name and surname of the user)