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Company Name:

[Your Online Store Name]

Address:
[Street Address]
[Postal Code, City]
[Country]

Owner/Responsible Party:
[Your Full Name]

Contact Information:
Email: [Your Contact Email Address]
Phone: [Your Phone Number]

VAT Identification Number:
[If applicable, include your VAT ID, e.g., "DE123456789"]

Commercial Register Entry:
[If applicable, include the register name, number, and place]