Layout Block - Block Reference - Baby Box

Last name / first name of child's legal representative *

Child’s first name *

Number and Street name *

Post code - City *

Phone *

Email *

Child’s date of birth * *

Jour

Mois

Année

* Offre valable uniquement pour les enfants nés endéans les 12 derniers mois.

Select your nearest branch to pick up your Baby Box *

Are you a Raiffeisen customer? *

Oui

No