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Company Name*

Company Type*

Name*

First name Middle name Last name

Email*

Address*

Address Address2 City Zip Country

Phonenumber*

VAT number*

Chamber of Commerce number*

Chamber of Commerce extract

Royal Flora Holland administrationnumber

Bank

IBAN number

Transporter*

Bring products to location

Pick up products at location

Language

Invoice address

Street + number City Postal Code Country

Invoice e-mail address

EKT/ EAB e-mail address

How did you find us?

Name

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