Italy Factory outlet

Filling this form, Your Factory Outlet will be instantly on line

credit card's holder first Name *
credit card holder's last name*
Outlet/shop name *
VAT number *
e-mail to send You confirmation, and one to adverise *	Please, check it

User name *

Please, enter a user-name. It must be between 4 and 12 characters long (using letters and numbers only).

Password *

Please, make a password. It must be between 4 and 12 characters long (using letters and numbers only).

Re-enter the password, thankYou *

Ripeti la password per conferma.

Nation and District*
Full address, ZIP code, town, province *
Telephone and Fax number*
Your web site *	If You do not have, plese write NO ONE

Annual subscription

Select the subscription

Discount
Offer a discount, to the visitor of this web site.They will present a bonus

Scegli lo sconto

Credit card information
- Your credit card will be charge for the amount above choose.
The merchant that make the transaction is : Autostop & Pendolari that will make the invoice

Select the type of card

We accept only Credit Cards : NO Visa Electron - NO Debit card - No Bancomat

fill in the full number of Your credit card*

Expire date (month/year)*

Describe Your products and offers

Describe Your products and offers *

Direction to reach Your Outlet *

Please, send Outlet photos to a:info@italyfactoryoutlet.com

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fill in the full number of Your credit card*
Expire date (month/year)*

Describe Your products and offers *
Direction to reach Your Outlet *