1. Nome(*)
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  2. Cognome(*)
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  3. Ditta/Agenzia(*)
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  4. Nazione(*)
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  5. Provincia(*)
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  6. Città(*)
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  7. Indirizzo(*)
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  8. CAP(*)
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  9. Recapito Email(*)
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  10. Recapito Telefonico(*)
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  11. Numero di FAX
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  12. Attività
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  13. Note
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