Request Form

Request the license agreement

Company

Department

First Name*

Last Name*

Address*

ZIP*

City*

Phone

E-Mail*

Website

If the licensee is not the applicant, please also provide the contact details of the applicant.

Company

Department

First Name

Last Name

Address

ZIP

City

E-Mail

Type of final goods*

Name of the company who is placing the final goods on the market

Produced Article Amount (Pieces)

Produced Textile (Indication meter or kilogram)

Country of production, where chemical is applied*

Ordered Quantity of RUDOLF Products & Name*

Distributor (Company)

Message

By submitting your request, you agree to the processing of data provided for processing your request (privacy statement).

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