Customer registration form
General information
Who is your contact at Veraleza
Trading name
*
Company name
*
Tax ID / VAT
*
Address
*
Number
*
City
*
Province / State
*
Postcode
*
Country
*
Delivery address
Same as company address
Delivery address
*
Number (delivery)
*
City (delivery)
*
Province / State (delivery)
*
Postcode (delivery)
*
Country (delivery)
*
Phone 1
*
Phone 2
E-mail for orders
*
Administration e-mail
*
Contact person
*
Website
Taxes
VAT type
Select…
Standard
Intracomunitary
Reduced
Super-reduced
Exempt
Equivalence surcharge
*
Select…
No
Yes
Other (details)
Customer type
*
Select…
Florist
Garden centre
Wholesaler
Decorator
Agricultural
Other
Customer type details
*
Financial data
Payment method
*
Select…
Confirming
Cash
Direct debit
Card
POS terminal
Bank transfer 30 days
Bank account (Spain only)
*
Bank (4 digits)
*
Branch (4 digits)
*
Account nº (10 digits)
*
Generated IBAN
*
The IBAN will be generated automatically when bank, branch and account number are completed.
SWIFT (BIC)
*
Bank name
*
Fixed payment days
Remarks
Signature
Mr./Ms.
*
Customer signature
*
Sign
Signature pending.
You must sign before submitting the form.
Verification
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*
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are mandatory.
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