Loyalty program

To enter into a Loyalty program and use the Order Center, please fill in the form below.

Name of the company*

Registration code*

E-mail*

Authorized person to sign contracts*

Contacts (name, e-mail, phone, identity number)

Business would like to become user of the ordering center

Yes

Invoices e-mail address

If different from given e-mail address

Delivery address/es of the goods

If different from the legal address

Authorized person/s to order / purchase goods

PLEASE FILL ALL THE BOXES BY PERSON!

Name (1)

Identity number (1)

Phone number (1)

E-mail (1)

Please add personal e-post for every person

Name (2)

Identity number (2)

Phone number (2)

E-mail (2)

Please add personal e-post for every person

Name (3)

Identity number (3)

Phone number (3)

E-mail (3)

Please add personal e-post for every person

Notes

Date*

Name of applicant*

Applicant's e-mail*

Applicant's phone number*

The data submitted by you will be kept confidential only for the purpose of Puhastusimport Ltd.