Application for the dealer agreement

1. Business

Registered business name:

Address:

Zip Code:		City:

VAT no.	Main phone no.:		Direct phone no.:

2. Contact person purchasing

Name:

E-mail:

Phone no.:

3. E-mail application

Invoice:

Offer:

Track and Trace:

4. Credit information

I would like the following terms of payment to be met:

payment up front/payment card
Credit

5. Access to Fourcom’s website

If you want a specific password to Your account please, write it below. Otherwise the password will be assigned to Your account with a possibility of changing it after first login.

Specific Password:

6. Terms

Fourcom ApS Østre Fælledvej 8 9400 Nørresundby Send your proposal of terms to: salg@fourcom.dk or by fax number +45 9632 2101 The undersigned hereby certifies that future trading will be taking place according to the Fourcom's current trading, sales and delivery terms: