Limes Image Agency

Summary

Confirmation

(Fields with * are mandatory)

Address

Email Address:*

Company:

Title:*

First Name:*

Surname:*

Nickname:*
This name will be displayed on our website!

Date of Birth:*

(DD/MM/YYYY)

Street / House No.:*

Postal Code:*

City:*

Country:*

Telephone:

Bank Account

You can enter your bank data at a later date in your personal area.
If for the bank transfer your bank data is still missing, we will inform you by email. I am the holder of the account. Your income will be transfered to this account:

Banking Institution:

Account Number:

Bank Code / SWIFT:

IBAN:

All of your personal data will be securely transferred with SSL encryption.

Data Protection Notice We shall not transmit your data to other third parties or make use of them for advertising purposes. You can effect a deletion of your data at any time. Please send us an email.