Company’s name:	*
Address in Spain:
Post code:	*
City:	*
Telephone:	*
Fax:
E-mail:
Main activity:	*
Nº of employees:	*
Slot machines:	YES           NO *              Nº
Year of construction /rebuild	*
Surface construction:	m2 *
Security *
Metal bars. Shutters or blinds of wood or aluminium in all openings. Metal shutters. Other
Alarm:	YES        NO
Alarm connected to a Security Center	YES        NO
When you close do you use the same security during the day as at night?	YES        NO
Capitals to insure
Building:	€ The structure, and walls, gates, fences, central heating, air conditioning, parquet flooring etc. and in general all elements in connection with the building (sun blinds, awnings, terrace enclosures, etc.).
Building alterations:	€ (improvements incorporated  such as air conditioning, gates, sun blinds, terrace enclosures etc.)
Contents:	€
Do you close more than 30 consecutive days a year?	YES        NO
Additional Information: If you cannot complete any of the above or you need further information, please note it in additional Information.
I would like to receive the information by:
E-mail Fax Telephone Mail A personal visit from the Broker           In person in Duñach's office in Roses  In person in Duñach's office in Empuriabrava