Application for a customer contract

Customer details

Business name *
Registration number *
Address *
Name and position of authorised signatory *
Main area of activity *
Contact phone *
E-mail *
Bank account no. *
VAT number *
Requested credit period *
Additional information

Authorised persons

Full name, personal identification code *

Customer's vehicles

Make, model, year, registration number and user *

Application filled in by

Name *
Position *
Phone *
E-mail *
Partnerid