Product name

Product article number

Name*

Company

City*

E-mail*

Telephone*

Consent* By completing and submitting this form you give your consent to the submitted data being stored and processed by LVI Low Vision International. This data is used so that we can provide you with relevant information regarding the product you have expressed interest in. This data will be stored for a maximum of 14 months.

I have read and understood the information provided and give my consent to the processing and storage of my personal data.

If you would like us to erase your personal data at an earlier date than that stated above, please don’t hesitate to contact us.

Cancel Send