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Supplier Form

  • Supplier Form

    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 email the completed form.

  • Company Details

  • Contact Details

  • Documents and Information required only for goods suppliers

  • Documents mandatory to be provided*

    Certified copy of company registration (Chamber of Commerce) not older than 3 months.

    If the company has been established less than 2 years ago the documents below are also mandatory to be provided:

  • Max. file size: 128 MB.
    proof taxes are paid
  • Max. file size: 128 MB.
    Copy certificate of foundation

  • Location where goods will be shipped from if different from visiting address

  • Tell us what you can offer

    You can select multiple options.

  • Declaration

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

  • 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.