ITAD Application Form – English - Flex IT Distribution

Thank you for your interest in becoming a Flex IT ITAD customer. Following Supplier Due Diligence regulations and guidelines, we are asking our trade accounts to provide full details about their company and business. Please complete all fields below, tick the declaration statements and submit the form. After submitting the form we will reach out to you as soon as possible.

1. Company and Contact Details

Company Name*

Trading Name

Parent Companies

Nature of the Business

Visiting Address*

Visiting ZIP Code*

Visiting City*

Visiting Country*

Chamber of Commerce No.*

Chamber of Commerce extract*

Max. file size: 10 MB.

VAT Number*

Bank Name*

EU VAT Number*

Bank City*

Date Established*

Bank Account (IBAN)*

Preferred Language

Bank Account SWIFT/BIC*

Website URL

Phone Number

Invoice Currency*

Main Sales Contact

Position

Telephone Number

Email Sales

Admin Contact*

Position

Telephone Number Admin*

Email Admin*

2. Declaration

This form has been (digitally) filled in by an authorized person. By signing this form the Vendor explicitly states the above stated company data are complete and accurate and accepts the attached purchase conditions of Xeptor B.V. Please note that we will exclusively use the above filled bank accounts for payments to your company.*

I hereby declare that I am authorized to declare to the following, and I confirm that the information provided is complete and correct.

Name*

Position*

Authorized signature (Digital)*

Apply Signature

Legal Disclaimer: The received information will be treated confidentially and in accordance with the applicable data protection laws. We shall only disclose the information if such disclosure is required by law or by an order of any governmental body or regulatory authority or court of jurisdiction. Information which has been made available by third parties or has been independently developed by us shall for this purpose not qualify as confidential.

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ITAD Application Form – ENG

1. Company and Contact Details

2. Declaration

Contact Information

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Offer your legacy, depreciated hardware to the Flex IT Distribution IT Recovery program.