NATIONAL DISTRIBUTOR

If you wish to be our official distributor products please complete this form:

  National

Wholesaler
Retailsaler
Coverage zone

  Fiscal data

N.I.F.
Name
Address
Postcode
City
Phone
FAX
E-Mail

   In compliance with the S.D. 93/42 and R.D. 414/96 "Health Products"
   Date of Establishment for Communication C.C.A.A.
   (art. 16.3)

   For the correct application of I.V.A.
  Are you or not subject to the surcharge scheme Equivalency.?
   Yes No

   If the delivery address or the name of the company is different  from
   the fiscal one you must complete this section

Banner of the establishment
Delivery Address
Postcode
City
Phone
FAX
E-Mail

   For the processing of granting credit line (until it is approved L / C   valuations will be carried out with pro-forma advance payment, except to    formalize the bank guarantee that we have already established).

Bank
Home office
Office Postcode
City
C.C.C
(total of 20 digits)

  Other your usual suppliers

 

Back