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Belgium: +32 (0) 15 480 563
Bulgaria: +35 (0) 956 916 921
Denmark: +46 (0) 31 38 91290
Finland: +46 (0) 313 89 1290
France: +33 (0) 1 86 65 22 86
Germany: +49 (0) 610 3993 3300
Italy: +39 (0) 298 650 081
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Spain: +34 (0) 93 220 33 47
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UK: +44 (0) 845 644 2252
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ITAD Application Form – ENG
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.
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
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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