Provider and Responsible Party
[Your Company Name / Your Name] 
[Legal form, e.g., “Sole Proprietorship” / “GmbH” / etc. (if applicable)] 
[Street + House Number] 
[Postal Code] [City] 
[Country] 

Phone: [Your phone number] 
Email: [Your email address] 

If applicable: 
Commercial Register: [Register court + registration number] 
VAT-ID: [Your VAT-ID] 

Authorized Representative: [Name of authorized representative, e.g., Managing Director]