Name  
  Address  
  E-mail  
  Telephone  
10 euros / year 1 annual payment        
40 euros / year 1 annual payment        
50 euros / year 1 annual payment 2 annual payments    
euros / year 1 annual payment 2 annual payments 4 annual payments
Current account (* number of digits):
Bank
(4*)		 Branch
(4*)		 Control
Digit
(2*)		 Account number
(10*)
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