Company:
Name of the contact:
Function:
E-mail:
Telephone
Business address
Town/city:
Address:
Postal code:
Postal address
Town/city:
Address:
Postal code:
Chamber of Commerce registration number
VAT number
Website:

 I would like to participate in Thuiswinkel.org's business partner programme and the following web-retailers (B2C, affiliated with Thuiswinkel.org) can be approached for references:

Reference 1
Company:
Name of the contact:
Function:
Telephone:
E-mail:
Reference 2
Company:
Name of the contact:
Function:
Telephone:
E-mail:

This application form should be accompanied by:
A certified copy of registration with the Chamber of Commerce, no more than 3 months old.
Your organisation's current annual report

The applicant declares having read the information, conditinos and criteria mentioned on the website www.thuiswinkel.org and understands that acceptance as a business partner will depend on the decision of the ballot committee.

My immediate, demonstrable involvement in the branch in general, and with members of Thuiswinkel.org in particular, relates to the following category:

Main category	Tick 1 only
Address Data
Advice Consultancy
Customer Contact
Distribution Logistics
Financial Services
ICT Services
Marketing Communication bureaus
Research bureaus
Print, Mail & Fulfilment
Software
Goods Comparison Sites
Can't find your category? Enter a suggestion here:
Other, please specify

The undersigned declares having completed this form truthfully.

Name:
Function:
E-mail:
Telephone: