Supplier Form
ITAD

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.

* Required Field

1. Company and Contact Details

Company Name*(Required)

Trading Name

Parent Companies

Nature of the Business

Visiting Address*(Required)

Street Address City Zip / Postal Code Country

Telephone number

Website URL

Chamber of Commerce No.*(Required)

Chamber of Commerce extract*(Required)

Accepted file types: pdf, jpg, gif, png, jpegformat, Max. file size: 128 MB.

VAT Number*(Required)

EU VAT Number*(Required)

Bank Name*(Required)

Bank City*(Required)

Bank Account (IBAN)*(Required)

Bank Account SWIFT/BIC*(Required)

Preferred Language*(Required)

Invoice Currency*(Required)

Main Sales Contact

Position

Telephone Number

Email Sales

Admin Contact*(Required)

Position

Telephone Number Admin*(Required)

Email Admin*(Required)

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.*(Required)

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

Name(Required)

Position(Required)

Authorized signature (Digital)(Required)

Apply Signature

Declaration:*(Required)

I/We hereby declare that the information provided is complete and accurate. The terms and conditions and our Privacy Policy stated overleaf have been read and agreed to. All relevant enclosures as requested are included with this form. I/We understand that Flex IT will carry out regular checks to ensure creditworthiness is maintained.

I confirm that I have read and agree to the above declaration.

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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info@flexitdistribution.com

+31 (0) 71 800 1460

Supplier Form
ITAD

1. Company and Contact Details

2. Declaration

info@flexitdistribution.com

+31 (0) 71 800 1460

Zaalbergweg 9 2314XS Leiden The Netherlands

COC: 70449740

VAT: NL858321488B01

Flex IT Distribution

Flex IT Rent

Supplier Form ITAD

1. Company and Contact Details

2. Declaration

Supplier Form
ITAD