Customer application form

Customer Request Form

Company Name *(Required)

Website*(Required)

Business type*(Required)

Billing address*(Required)

Street and House Number City ZIP / Postal Code Country

Phone number*(Required)

COC number*(Required)

COC extract*(Required)

Accepted file types: pdf, jpg, gif, png, jpegformat, Max. file size: 128 MB.

VAT number

Contact person from your organisation*(Required)

Email address of your organisation’s contact person*(Required)

Invoice email address*(Required)

Delivery email address*(Required)

Accounts payable email address*(Required)

Email address of your contact person at Infotheek*(Required)

I hereby declare that I am authorised to make the following declaration and agree to it.*(Required)

Hierbij ga ik akkoord dat ik [Voornaam/Achternaam/Functietitel/namens bedrijf] gemachtigd ben om het volgende te verklaren en hiermee akkoord te gaan.

First name*(Required)

Surname*(Required)

Job title*(Required)

On behalf of the company*(Required)

I hereby declare that the information provided is complete and accurate.*(Required)

I hereby agree that the information provided is complete and accurate.

Declaration*(Required)

I hereby declare that Infotheek has informed the above-mentioned legal representative in a timely manner about the Infotheek General Terms and Conditions via the attached link and has indicated that these Terms and Conditions can be downloaded through this link, in the context of this customer request form.

I hereby agree that the Infotheek General Terms and Conditions have been provided and are available via this link.

I hereby declare that I, the above-mentioned legal representative, have been informed in a timely manner by Infotheek about Infotheek’s privacy terms and that these privacy terms have been provided.

I hereby agree that Infotheek’s privacy terms have been provided and are available via this link.

I understand that Infotheek performs regular checks to ensure that creditworthiness can be maintained.*(Required)

I hereby agree that Infotheek performs regular checks to ensure creditworthiness.

News and offers

Yes, I would like to receive emails with news and offers from Infotheek.