*Subject: Entrepreneur / Company
Private person

**Company name:
(Write the exact name stated in the Commercial Register)
**Company location:
***Telephone or mobile:
***E-mail or fax:
*Subject of interest:

*Supplier - town:
*Engine volume:
Special equipment:
****Year of manufacture:
*Means of financing: 
*Preferred length of repayment period: 
*Total price of product:   CZK
  incl. VAT excl. VAT
*Preferred amount of advance payment:  %
*Preferred amount of instalments:   CZK
*Preferred insurance company: 
*Preferred amount of participation: 
*Additional insurance: 
payment protection insurance
glass breakage insurance
personal accident insurance
luggage insurance, assistant service insurance, insurance of rental cost of a substitute vehicle
without supplemental insurance
*Preferred means of receiving offer : 
*Preferred time of receiving offer: 
By entering the data specified above I explicitly allow ČSOB Leasing, ID:63998980 (hereinafter "ČSOBL") to process my abovementioned personal and sensitive information in conformity with Act no. 101/2000 Coll. on personal data protection, for the purpose of the fulfilment of legal obligations, the negotiation of contractual relationship, the fulfilment of contractual obligations, the protection of the rights and interests of ČSOBL, its use within the framework of their subject of enterprise for the purpose of marketing their products and services and/or products and/or services of third parties, which are part of ČSOB’s concern, and for the purpose of the education of employees. This can be done either manually or automatically with the help of information technology, for a period of 10 years. I recognize the fact that I have the right to ask ČSOBL for information about personal data processing and that I have the option to request the removal of processed personal data which is not in conformity with legal regulations. By entering the data I agree to allow the use of my electronic contact details (namely telephone, fax or e-mail) for communicating business information intended for direct or indirect support of the products, services or image of ČSOBL.

*       Fields marked * must be filled in
**      Fields marked ** must be filled in only if the subject is an Entrepreneur /Company.
***    It is necessary to fill in at least one field marked ***.
**** Obligatory information for used products.