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Company Name*
Required
Canton*
Required
Select
Argovie - Aargau - Argovia
Appenzell Intérieur - InnerRhoden - Appenzello Interno
Appenzell Extérieur - AusserRhoden - Appenzello Esterno
Berne - Bern - Berna
Bâle - Basel Land - Basilea Campagna / Bâle Ville - Basel Stadt - Basilea Città
Fribourg - Freiburg - Friburgo
Genève - Genf - Ginevra
Glaris - Glarus - Glarona
Grisons - Graubuenden - Grigioni
Jura - Giura
Lucerne -Luzern - Lucerna
Neuchâtel - Neuenburg - Neuchatel
Unterwalden - Nidwalden - Nidvaldo
Unterwalden - Obwalden - Obvaldo
Saint Gall - Sankt Gallen - San Gallo
Schaffhouse - Schaffhausen - Sciaffusa
Soleure- Solothurn - Soletta
Schwyz - Svitto
Thurgovie - Thurgau - Turgovia
Ticino - Tessin
Uri
Vaud - Waadt - Vaud
Valais - Wallis - Vallese
Zoug - Zug - Zugo
Zurich - Zurigo
First Name*
Required
Last Name*
Required
Number of employees*
Required
Select
from 0 to 10
between 10 and 50
more than 50
Private Individual
Type of Service*
Required
Select
Recurrent Service (Bin destruction)
One Shot (Archive)
Hard Drive
Back Up (CD's, Tape's...)
Home Shredder
Document Scanning
Digital Data erasure
Other
E-mail*
Required
Wrong Email Format
Phone*
(000) 000 00 00
Required
Wrong Phone Format
Additional Information
Existing Customer*
Required
Please select an option
Yes
No
How Did You Hear About Us ?
Please select an option
Visit of a Katana representative
Show / Event
Word of mouth
Saw a truck on the streets
Social networks
Internet search
Other