Customer registration form
COMPANY DETAILS
Company Name
(Required)
Company Type
(Required)
Company Number
(Required)
VAT Number
(Required)
Angro Salesrepresentative
(Required)
CONTACT DETAILS
First name
(Required)
Last name
(Required)
Telephone number
(Required)
E-mailaddress
(Required)
INVOICE ADDRESS
Street + Nr.
(Required)
Postalcode + City
(Required)
Country
(Required)
GLN nr.
DELIVERY ADDRESS
(when different from invoice address)
Name Delivery Address
Street + Nr.
Postalcode + City
Country
GLN nr.
You will recieve invoice, orderconfirmation and packinglist digitally
CONTACT DETAILS FOR DIGITAL INVOICE
E-mail address
(Required)
Tel.nr.
(Required)
CONTACT DETAILS FOR DIGITAL ORDERCONFIRMATION (when different from invoicing)
E-mail address
Tel.nr.
CONTACT DETAILS FOR DIGITAL PACKINGLIST (when different from invoicing)
E-mail address
Tel.nr.
CONTACT DETAILS ADMINISTRATION
E-mail address
Tel.nr.
CONTACT DETAILS FOR EDI
(WHEN APPLICABLE)
Name
E-mail address
Tel.nr.
The undersigned states that the information filled in above is correct and true and agrees with the included general terms and conditions.
On behalf of the Company (authorised signature)
Name
(Required)
Date
(Required)
DD slash MM slash YYYY
City
(Required)
Signature*
(Required)
I have read and agree to the terms and conditions *
(Required)
I have read and agree to the
terms and conditions
*
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