Contact details form In order to include your company in our ERP system we would like to ask you to fill in the information below as completely as possible. General company information Company name(*) Invalid Input VAT number(*) Invalid Input COC number(*) Invalid Input Visiting address Street Invalid Input ZIP Code Invalid Input City Invalid Input Country Invalid Input Extra information Invalid Input Shipping address Street Invalid Input ZIP Code Invalid Input City Invalid Input Country Invalid Input Extra information Invalid Input Invoice address Street Invalid Input ZIP Code Invalid Input City Invalid Input Country Invalid Input Extra information Invalid Input Contact details Company website Invalid Input General e-mail address(*) Invalid Input Company phone number(*) Invalid Input Company fax number Invalid Input Logistics / packing slip Contact person Invalid Input Phone number Invalid Input E-mail address Invalid Input Purchase / order confirmation Contact person Invalid Input Phone number Invalid Input E-mail address Invalid Input Account Dep. / invoices Contact person Invalid Input Phone number Invalid Input E-mail address Invalid Input (*) I agree with the general terms and conditions of Dertec Invalid Input Send
