| Tipul cererii/Type of request             (*) |    | 
		
			| Specificatie cerere/Specification        (*) |  | 
		
			|  |  | 
		
			| Societatea/Company                      (*) |  | 
		
			| Numele-prenumele/Name-Surname (*) |  | 
		
			| Adresa/Address                             (*) |  | 
		
			| Cod postal/ZIP |  | 
		
			| Localitatea/City                             (*) |  | 
		
			| Tara/Country |  | 
		
			| Telefon/Telephone                        (*) |  | 
		
			| Fax: |  | 
		
			| eMail                                           (*) |  | 
		
			|  | 
		
			| Introduceti aici informatii cat mai    (*) detaliate asupra cererii Dumneavoastra: Introduce here most detailed information about your request |  | 
		
			|  | 
		
			| Cum ati gasit VFM Service ? /How have you heard about us ? | Motor de cautare/Search engine | 
		
			|  | Recomandare/Reccomendation | 
		
			|  | Literatura specialitate/Literature | 
		
			|  | Altele/Other | 
		
			|  |  | 
		
			| Apasati aici pentru expediere la VFM Service /Click here to send |  | 
		
			| Resetati/Reset |  |