Please, fill in the form COMPLETELY and press the button validation below.

Then, print out the form and fax it, stamped, dated and signed, with :

  1. A valid Company Registration Document.
  2. BIZCOM Europe Terms and Conditions of Sales signed.

To the following Fax number : +33 (0)4 90 39 63 62.
 
Company information
Company Address
Company name*
Address*

City*
State/Province*
ZIP or Postal Code *
Country*
VAT Number*
Company Number registration*
Company Contact
Last name *
First name *
Job title *
Email *
Phone number *
Mobile number *
Fax number *
Auction and bids Contact
Last name *
First name *
Email *
Phone number *
Partner Project Name
Name*
Sale representative on partner side
Name *
 
Financial / Accounting information
Billing Address
Address*

City*
State/Province*
Zip or Postal Code *
Country*
Billing Contact
Last name *
First name *
Job title *
Email *
Phone number *
Mobile number *
Fax number *
 
Shipping / Delivery information
Delivery Address
Company name*
Address*

City*
State/Province*
Zip or Postal Code *
Country*
Delivery comment
Delivery Contact
Last name *
First name *
Job title *
Email *
Phone number *
Mobile number *
Fax number *
 
Bank information
Bank information
Credit Institution / Bank name *
Account no. *
Bank Code *
Branch name *
Bank address *
Bank contact *
Phone number *
IBAN *
BIC (SWIFT) *
 
* required fields
 
BIZCOM Europe is legitimed to collect a bank inquiry at the named credit institutions.