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General information
DutchFix Service Application

Company Name*

Company Name*

Type of business*

Type of business*

Type of legal entity*

Type of legal entity*

Phone number*

Phone number*

Ceo or legal representative full name*

Ceo or legal representative full name*

Email address*

Email address*

Website

Website

Invoice/Delivery address*

Invoice/Delivery address*

Delivery address

Delivery address

If different

Accountant name*

Accountant name*

Accountant email address*

Accountant email address*

Company registration NO.*

Company registration NO.*

VAT Registration NO.*

VAT Registration NO.*

Number of empoyees*

Number of empoyees*

Date of registration*

Date of registration*

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Bank details

Name of bank*

Name of bank*

IBAN*

IBAN*

Address*

Address*

SWIFT*

SWIFT*

Country of bank*

Country of bank*

Account holder*

Account holder*

Phone number*

Phone number*

Number of years with bank*

Number of years with bank*

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References
Possible trading platforms

Name of bank

Name of bank

TRADE REFERENCE 1

Address

Address

TRADE REFERENCE 1

Phone number

Phone number

TRADE REFERENCE 1

Name and Surname

Name and Surname

TRADE REFERENCE 1

Name of bank

Name of bank

TRADE REFERENCE 2

Address

Address

TRADE REFERENCE 2

Phone number

Phone number

TRADE REFERENCE 2

Name and Surname

Name and Surname

TRADE REFERENCE 2

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Authorization for online and phone orders

E-mail orders allowed*

E-mail orders allowed*

Phone orders allowed*

Phone orders allowed*

Telephone orders allowed*

Telephone orders allowed*

WhatsApp orders allowed*

WhatsApp orders allowed*

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Traders / Contact for sale & purchase / Brokers who are allowed for orders

First & Last name*

First & Last name*

Person 1

Phone number*

Phone number*

Person 1

E-mail address*

E-mail address*

Person 1

First & Last name

First & Last name

Person 2

Skype ID

Skype ID

Person 2

Phone number

Phone number

Person 2

E-mail address

E-mail address

Person 2

First & Last name

First & Last name

Person 3

Skype ID

Skype ID

Person 3

Phone number

Phone number

Person 3

E-mail address

E-mail address

Person 3

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IMPORTANT - PLEASE SUPPLY THE FOLLOWING:

Company Incorporation Certificate.*

Company Incorporation Certificate.*

(Please remember that we treat this information with the strictest confidentiality.)

This type of file isn't allowed
The file size must be up to 100 MB

VAT Certificate*

VAT Certificate*

(Please remember that we treat this information with the strictest confidentiality.)

This type of file isn't allowed
The file size must be up to 100 MB

Completed references and company representatives*

Completed references and company representatives*

(Please remember that we treat this information with the strictest confidentiality.)

This type of file isn't allowed
The file size must be up to 100 MB

Bank Account Details*

Bank Account Details*

(Please remember that we treat this information with the strictest confidentiality.)

This type of file isn't allowed
The file size must be up to 100 MB

Copy of recent utility bill (Electric/Water/Gas/Landline Telephone).*

Copy of recent utility bill (Electric/Water/Gas/Landline Telephone).*

(Please remember that we treat this information with the strictest confidentiality.)

This type of file isn't allowed
The file size must be up to 100 MB

Director ID document *

Director ID document *

(Please remember that we treat this information with the strictest confidentiality.)

This type of file isn't allowed
The file size must be up to 100 MB

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Terms and Conditions

Agreement to the Company’s Terms and Conditions

Agreement to the Company’s Terms and Conditions

1. The Customer acknowledges and agrees that the Company’s Terms and Conditions for the Supply of Goods, which the Customer has received or are attached, will govern all sales to the Customer. The Customer agrees to adhere to the Terms for each transaction. The Customer understands that the Company may update these Terms occasionally, and the revised Terms will apply to transactions after the Customer has been informed of any changes. All terms are attached on the final invoice.
2. The Customer acknowledges that acceptance of this application by the Company will result in a modification of the Terms. The Customer confirms that if credit facilities are granted, it will adhere to the payment terms outlined and agrees that failure to do so will allow the Company to immediately withdraw the credit facility without notice, making all outstanding amounts immediately due.
3. In evaluating this application for credit facilities, the Company will induct inquiries with credit reference DutchFix Service B.V. and other third parties. which may document these inquiries. The Company may also share information regarding the Customer’s account activities, credit reference agencies and other third parties. Information obtained or provided to these agencies may be utilized for assessing future credit applications, dept collection, tracing, and fraud prevention.
4. The Customer hereby declares that all purchase and sale documents between our companies will be included in their tax books & tax declarations. Moreover hereby declare that the goods sold by mentioned above, to the best of our knowledge come from a legal source. The place of jurisdiction for all disputes under the contractual relationship with DutchFix Service B.V. shall be the competent court in the Netherlands. The customer declares that all statements that were made are, to the best of our knowledge, correct and complete. At last also declare that they are paying taxes according to current VAT laws. This form serves as authorization for all mentioned persons, delivery addresses and communication information.
5.For comprehensive details regarding the Company’s practices on collecting, processing, storing, and retaining personal data-including the purposes for which the data is used, the legal grounds for its use, the rights of the individual, and any applicable data sharing-please consult the Company’s Privacy notice available upon request.

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