Company Name*

Company Address*

Warehouse Address
(if different from above)

Opening hours Warehouse

Trade Register Number*

WDL Number
(please enclose a copy)*

WDL issue date

WDL expiry date

VAT Number

Tel.*

Fax

Email Address*

Name of responsible Person according to GDP*

Position

Tel.

Fax

Email Address

Account Name

Bank Name

Sort Code

Account Number

IBAN

BIC

Currency