name or company name and permanent address or registered place of business of the wholesale distributor in the source Member State and of the wholesale distributor in the destination Member State.
ainm nó ainm cuideachta agus seoladh buan nó áit ghnó chláraithe an dáileora mórdhíola sa Bhallstát foinseach agus an dáileora mórdhíola sa Bhallstát cinn scríbe.