26 April 2016

Customer application form

Company name*

Name contactperson*

Function contact*

E-mail contact*

Address*

Phone number*

Website


Company information

VAT number

IBAN number

Bank identification number (BIC)

Type of company

Specialist tire assembly (chain)

Specialist tire assembly (independent)

Wholesaler

Brand dealer

Government

Universal garage

Otherwise

Additional information about your business