Mosaico Diffusion

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	A Travel Agent
	A website
	A hotel
	A Workers' Council / Group
	A Transportation Company

Commercial affiliation

	Affiliation form
	Terms of Affiliation

Web affiliation

	Affiliation form
	Terms of Affiliation

Communication tools

	Summer Festivals Pass presentation
	Banners & Logos
	Info on Events

Mosaico Affiliation

Please fill in all the fields on the following form. You just have to click on "Submit" and our Afiliation department will study your request. You will receive an e-mail in the next days to let you know you if your affiliation has been accepted. Any Questions ? business@mosaicodiffusion.com

Mosaico Commercial Affiliation Form

	Your company :

* Corporate name :

Company Registration Number :

Fiscal status : (company or association)

* Address :

* Postcode :

* Town :

* Country :

* Language :

* E-mail :


	Your Billing :

* Name of the beneficiary of payments :

* Address :

* Postcode :

* Town :

* Country :

* Phone :

Fax :

E-mail :

	Are you submitted to VAT?
	VAT or European VAT number :
	Account Number (IBAN) :
	Bank Code :
	Country of bank branch :


	Additional information

This information helps us know your activity better, and enables us to suggest you the tools that fit best your needs

* You are :

other (specify)

Nature of your activity

Commercial names

Size of your company (number of employees)

Year 2003 Turnover

	Does your company have a network of branches ? If yes, how many ?	yes no

	Does your company have several sales offices, agencies ? If yes, how many ?	yes no

	Does your company have a web site ?	yes no
	If yes : Name of your website :
	URL of your website :
	Is your service available in several languages ?	yes no
	If yes, which ones ?

From which countries do your customers mainly come from ?
What is your customer target ?
Do you offer special rates for groups and/or Workers' councils ?	yes no


	Your access to your dedicated section at www.mosaicoworld.com :

* Password requested :
* Password confirmation


	(This password will be reminded in the confirmation e-mail that you will receive)


	Confirmation :

* I certify that the information put on this form are correct
* I hereby declare that I have read the General Terms for Mosaico Commercial Affiliation by Mosaïco Diffusion, which I accept without any restraint as juridical framework for our partnership.
* I agree that the electronic signature is the proof of my compromise.

Your information are for Mosaïco Diffusion's use only. You have a right to access, modify, rectify and delete your data (art. 34 of french law "Informatique et Libertés" N°78-17 from January 6th 1978). To use this right, please contact us at : Mosaïco Diffusion – Commercial Affiliations 48 Bvd de Picpus 75012 Paris France

* Required Fields