TRADING NAME
TRADING ADDRESS
CITY/TOWN
POST-CODE/ZIP-CODE
COUNTRY
TEL
FAX
EMAIL
CUSTOMER SERVICES CONTACTS
NAME TEL EMAIL
OPERATIONS CONTACTS
NAME TEL EMAIL
ACCOUNTING
EMAIL ADDRESS FOR E-BILLING 1 -
2 -
SELECT FORMAT FOR E-BILLING PDF CSV XLS
COMPANY REGISTRATION N°
COUNTRY OF REGISTRATION
VAT REGISTRATION N°
AUTHORISATION

On behalf of the CUSTOMER, the undersign hereby applies for an account to be opened and credit facilities to be granted by the company. The CUSTOMER hereby certifies that all the information given in connection with this Credit Application is true, complete and correct. The CUSTOMER hereby agrees to abide the GENERAL CONDITIONS of TRADING of the COMPANY.

FOR AND BEHALF OF (CIE NAME)
SIGN BY
PRINT NAME
DATE