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CuliShop Import
Kromme Sâne 14
8491 PE Akkrum
Friesland
the Netherlands

info@culishop.com
www.culishop.com

Application form PartnerAccount


With this form you can request your own PartnerAccount. Do not forget to include or send a copy of your registration of the Chamber of Commerce and a minimum of two images (interior and exterior) to:

CuliShop Import
Kromme Sâne 14
8491 PE Akkrum

The images can also be included within this application form

Without these supplements/attachments we can not review your application!

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Contact person *
Gender Male Female *
Company *
Billing address *
Billing postalcode *
Billing city *
Billing country *
Delivery address *
Delivery postalcode *
Delivery city *
Delivery country *
Phonenumber *
Faxnumber
E-mail *
Website
Chamber of Commerce registrationnumber * (unless pending)
VAT number * (unless pending)
Bank account *
Motivation / comments *

Image of interior
Image of exterior
* required fields.

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