You will receive a status of Authorised Contracting Partner (ACP)
provided that you fill in and submit this application.

Please fill in all the gaps in this application form.

Full name of your company
Province	-- select -- (other country's provice) dolnoslaskie kujawsko-pomorskie lubelskie lubuskie lodzkie malopolskie mazowieckie opolskie podkarpackie podlaskie pomorskie slaskie swietokrzyskie warminsko-mazurskie wielkopolskie zachodniopomorskie
Country
Headquarters address	city	code
	address:
Accommodation address	city	code
	address:
NIP:
REGON
Phone number
Fax number
e-mail address
www address
A person to contact
(his or her first name, surname, phone number)
sort of business operations	Computer shop
	Computer wholesaler
	Subunits distributor
	Computer distributor
	Computer maker
	Software developer
	IT system integrator
	Internet service provider (ISP)
	Other:
I agree to receive the commercial information from Gulipin Sp. z o.o. to my electronic address and to process this address on data base according to the principles specified in the regulations of the Act on Services Provided Electronically dated July 18, 2002 (Journal of Laws no 144, item 1204).