You wish to join our Network and become one of our preferred providers listed on our website?

Please fill out the following information. Our Network department will contact you for delailed negotiation. (*mandatory field)

Provider Name*:

Type:

Address*:

Zip code*:

City*:

Country*:

Contact Department*:

Contact Person*:

Phone*:

Fax:

E-mail*:

Where did you hear
about Mobility Benefits:

If other please state:

In which way would you prefer
to get the feedback:

Please enter details of anything
you would specifically like to
discuss with us:

PRIVACY AND PERSONAL DATA PROTECTION

As provided by the French law of January 6, 1978 on Data Protection (loi Informatique et libertés), amended in 2004, you have the right to access and rectify any personal information that we have on file pertaining to you. You may exercise this right by writing to: S2H – Direction juridique – 18 rue de Courcelles 75384 Paris Cedex 08 – France.

For information, see Legal Notices