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| Tax Registration Number: |
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| Business Name/Complete Name: |
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| *Name of the Business in case of legal person and complete Name in case of natural person. |
| Brand (if appropriate): |
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| Line of Business / Activity: |
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| Legal Representative: |
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(*) Obligatory for Legal Persons
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| Yearly Invoicing : |
* |
| * It corresponds to the company's total invoicing for the year |
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Certifications:
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| Contact Details |
| Address: |
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| District / Borough: |
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| City: |
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| Region: |
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| Country: |
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| Telephone 1: |
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Country Code– Area Code – Phone number (56-2-2803000)
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| Telephone 2: |
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Country Code– Area Code – Phone number (56-2-2803000)
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| Fax 1: |
*
Country Code– Area Code – Phone number (56-2-2803000) |
| Fax 2: |
*
Country Code– Area Code – Phone number (56-2-2803000)
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| Contact Person: |
*
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| Contact E-mail: |
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| Repeat E-mail: |
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| URL/Web Site: |
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| Branches*: |
0
1
2
3
4 |
| * Only if you have a branch or agent located in Región de Valparaíso, Región del Bío Bío, Región de Magallanes y la Antártica Chilena or Región Metropolitana (RM). |
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