Supplier Form FlexIT 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 DetailsCompany Name*(Required)Trading NameParent CompaniesNature of the business(Required)Visiting Adress*(Required) Street Address City Zip / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Telephone number*(Required)Website URLChamber of Commerce No.(Required)Copy of the Articles of association of the company(Required)Copy certificate of foundationAccepted file types: pdf, jpg, gif, png, jpegformat, Max. file size: 128 MB. VAT/GST NumberCopy of VAT certificateProof taxes are paidAccepted file types: toegestanebestandstypen:pdf, jpg, gif, png, jpegformat, Max. file size: 128 MB. Date Established MM slash DD slash YYYY Preferred LanguageInvoice Currency(Required)Bank Name*(Required)Bank City*(Required)Bank Account (IBAN)*(Required)Bank Account SWIFT/BIC*(Required)Contact DetailsMain Sales Contact*(Required)Position*(Required)Telephone Number*(Required)Email Sales(Required) Finance Contact(Required)Position(Required)Telephone Number*(Required)Email Finance(Required) Documents and Information required only for goods suppliersChange of Ownership less than 1 year ago(Required) Yes No Change of Director less than 1 year ago(Required) Yes No Change of Business less than 1 year ago(Required) Yes No 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:Company Name & Address*(Required)EU VAT No. in Country of ShipmentTell us what you can offerYou can select multiple options.1. Computing Apple Dell HP Lenovo Microsoft 2. Enterprise APC Brocade Cisco Dell HPE Juniper Netgear Ubiquiti 3. Printing Brother Canon Epson HP Kyocera Lexmark 4. Accessories Apple Dell HPinc Lenovo Logitech Samsung Seagate WesternDigital 5. Status Circular (refurb) New 6. OtherYour Flex IT contact person(Required) Bart Keizer Bas Wognum Bram Bot Dennis Rosbergen Nard Hornes Peter Kok Michal Wroblewski Florian Wirth Harco Pennings Jan Willem Proper Sousanna Aristiadou Anya Baker Beata Jurkiewicz Sales Person Erna Borbas Vermeulen DeclarationThis 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.I accept the purchases conditions(Required) I accept the purchases conditions First Name*(Required)Last name*(Required)Authorized signature (digital) *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.CAPTCHA
