REQUEST FOR SPECIAL RATE
COMPANY – ASSOCIATION – CLUB

Please fill in this form as accurately as possible. The information as well as your estimated purchases will allow us to calculate your special conditions. As soon as your details have been analysed, you will receive confirmation and draft contract to sign with your special rate and conditions.

Company *

Reprensented by :

Surname *

First name *

Capacity *

Business activity / Aim of association *

Legal form LTD PLC Partnership other

Date of Consitution *

Address *

N° *

Box

Postal code *

City *

Country *

Telephone *

E-mail *

VAT N° or Company n° (necessary if available)

Estimated purchases from Schleiper (euros) *

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* mandatory fields