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

Which brands are you distributing already ?


Which brands are you distributing on an exclusive basis ?


How many shops do you deliver to ?


How many employees do you have ?


How many sales representatives do you have ?


What is your estimated yearly turnover for the applied brand ?


What is your estimated yearly turnover for the applied brand ?



What is the surface of your warehouse ?


What are your main marketingactivities ?


Other facts we definitely need to know ?

Do you want to receive our catalogues and price lists ?
 yes
 no


Do you want to receive our newsletters ?
 yes
 no


What brands are you interested in ?

Protech  Parkfun  FG modellsport  Navicraft  Oracover  Hacker

Team Radixx  Flightpower  Rextor Systems  APC props  XenoTools  Yuneec

Ishima Racing  Tornado Fuel  YES chargers  Rossi  Medial Pro  Fusion

Opening hours

	from	to	from	to
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY

Spoken languages

English  Dutch

French  German

Italian  Spanish  Other

Remarks/Questions you might have