ITAD Application Form – English - Flex IT Distribution

* Required Field

Statutory Company Name*

Website

Trading name

General Phone Number*

Invoice Address*

Street and House Number Address Line 2 City ZIP / Postal Code Country

Registered Address*

Street and House Number Address Line 2 City ZIP / Postal Code Country

Chamber of Commerce Number

Copy of company registration (Chamber of Commerce Extract)*

Accepted file types: jpg, gif, png, pdf, gif, jpeg, txt, doc, xlsx, csv, Max. file size: 128 MB.

VAT Number*

Hidden

Date of Establishment (dd/mm/yyyy)*

Bank Name*

Supplier Currency (AP)*

Bank Location (City)*

Customer Currency (AR)*

Bank Account Number (IBAN)*

SWIFT/BIC*

Contact Information

Contact information Sales*

Sales Contact Person Sales Phone Number Sales Contact Person Email Address Delivery Email Address

Accounts Payable Contact Person*

Accounts Payable Contact Person Accounts Payable Phone Number Accounts Payable Email Address Invoice Email Address

Accounts Receivable Contact*

Accounts Receivable Contact Person Accounts Receivable Phone Number Accounts Receivable Email Address

Email Address of your Contact Person at Flex IT

General Terms and Conditions (Customer & Supplier)

Details of Person Autorized to Sign*

First name Last name

Job Title On behalf of the Company

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

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

"I hereby declare that Flex IT has timely informed the above-mentioned legal representative via the attached link about both the Flex IT General Terms and Conditions and the Flex IT Purchase Conditions, and has made it known that both sets of terms and conditions can be downloaded in connection with this customer application form."*

I hereby confirm my agreement to both the Flex IT General Terms and Conditions, which have been provided and are accessible through this link, and to the Flex IT Purchase Conditions, which have been provided and are accessible through this link. I acknowledge that I have accepted these Purchase Conditions and understand that they will apply to all future transactions.

I hereby declare that I, the above-named legal representative, have been informed in good time of the Flex IT privacy conditions and Flex IT has provided these privacy conditions.*

I hereby confirm my agreement to the Flex IT Privacy Terms which have been provided through this link.

I understand that Flex IT carries out regular checks to ensure that the creditworthiness can be maintained.**

I agree that Flex IT (FlexIT B.V.) shall perform regular checks to ensure creditworthiness.

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General Terms and Conditions (Supplier)

This form has been (digitally) signed 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 FlexIT B.V.*

Correct

Please note that we will exclusively use the above filled bank accounts for payments to your company.

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Details Person Authorized to Sign*

Name Position

Please note that we will exclusively use the above filled bank accounts for payments to your company.

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

Contact Information

General Terms and Conditions (Customer & Supplier)

General Terms and Conditions (Supplier)

Contact Information

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