Invoice address
Company name
VAT number
Foreign customers without VAT-number pay Belgian VAT (21%) without retroactive effect. Export
Address
Postal Code
City
Country
Delivery address
Please mark here if the delivery address details are the same as the Invoice address details.
Company name
VAT number (*)
Foreign customers without VAT-number pay Belgian VAT (21%) without retroactive effect. Export
Address
Postal Code
City
Country
Contact details
Shop Details Shop phone
Shop fax
Shop e-mail
Shop website
Shop Owner Shop owner name
Shop owner e-mail
Shop owner phone or mobile
Shop Manager Shop manager name
Shop manager e-mail
Shop manager phone or mobile
Shop Accountancy Responsible Shop accountancy responsible name
Shop accountancy responsible e-mail
Shop accountancy responsible phone or mobile
Payment information
Wire transfer Credit card (fax or mail us CC details) LCR (France only) (fax or mail us RIB code) BANKEINZUG (Germany only) (fax or mail us Bankeinzug)
Additional information
What type of Shop do you have ? shop only shop + internet shop internet shop only Do you want to receive our catalogue and price lists ? yes noDo you want to receive our newsletters ? yes noWhat brands are you interested in ?
Opening hours
from
to
from
to
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
Spoken languages
Remarks/Questions you might have